CAMHS Crisis: in accordance with the Children Act 2004 (Joint Area Reviews) Regulations 2015, Her Majesty’s Chief Inspector of Education, Children’s Services and Skills (HMCI) has determined that a written statement of action is required because of significant weaknesses

Many mental health services for children and young people (CAMHS) and for people with learning disabilities in Suffolk are provided by Norfolk and Suffolk NHS Foundation Trust (NSFT).

NSFT is the dominant provider of mental health services in Suffolk.

NSFT has repeatedly claimed all is well in Suffolk and that the only problems are in adult services in Norfolk.

We have been campaigning for more than three years about the deeply inadequate services for children and young people in Suffolk as a result of funding cuts and the disastrous ‘radical redesign’.

In Suffolk, CAMHS suffered massive staffing cuts as greatly diminished and diluted services for children and young people were forced into Integrated Delivery Teams (IDTs).

At NSFT across Norfolk and Suffolk, CAMHS suffered the largest funding cuts of any mental health provider according to the NHS Benchmarking Agency.

NSFT is promoting a candidate to turn these services in Suffolk around who has little to no qualifications, relevant knowledge or proven experience in delivering mental health services for children and young people. We shouldn’t be surprised, as the consultant who led the establishment of the NSFT Youth Service in Norfolk had little to no experience or qualifications in CAMHS either.

Genuine service user and carer engagement and co-production of services is virtually non-existent at NSFT. Service user and carer representation is narrow, tokenistic, self-serving and inadequate. Until this changes, the culture of NSFT will not improve and mental health services will not meet the public’s needs.

In summary, CAMHS services across Norfolk and Suffolk were trashed by NSFT’s ‘radical redesign’. NSFT had the ‘audacity of hubris’ to call these changes ‘improvements’.

Suffolk is a wealthy county. Children and young people should not be let down like this.

Below are the relevant findings of the Ofsted and Care Quality Commission (CQC) inspection:

From 12 December to 16 December 2016, Ofsted and the Care Quality Commission (CQC) conducted a joint inspection of the local area of Suffolk to judge the effectiveness of the area in implementing the disability and special educational needs reforms as set out in the Children and Families Act 2014.

The inspection was led by one of Her Majesty’s Inspectors from Ofsted, with team inspectors including Ofsted Inspectors and Children’s Services Inspectors from the CQC.

As a result of the findings of this inspection, and in accordance with the Children Act 2004 (Joint Area Reviews) Regulations 2015, Her Majesty’s Chief Inspector of Education, Children’s Services and Skills (HMCI) has determined that a written statement of action is required because of significant weaknesses in the local area’s practice. HMCI has also determined that the local authority and the area’s clinical commissioning groups (CCG) are responsible for submitting the written statement of action to Ofsted.

The local area is required to submit a written statement of action to Ofsted which addresses how it will tackle the following areas of significant weakness.

• The ineffective governance and leadership of the joint strategic planning and delivery of the disability and special educational needs reforms.
• The poor timeliness, integration and quality of SEND statutory assessments and plans, this includes when statements of special educational needs are transferred to EHC plans, and the delivery of subsequent individual packages of support.
• The lack of local understanding of the support available and the poor quality of the local offer, including access to CAMHS support across the area, which lead to high levels of parental complaint and anxiety.
• The lack of joint working to monitor, quality-assure and maximise the efficiency of the work undertaken to improve outcomes for children in a diverse range of settings and circumstances.

The needs of many children and young people are not effectively met. Feedback from parents, in response both to the inspection and to a recent survey undertaken by the Suffolk Parent and Carer Network (SPCN), overwhelmingly reflects dissatisfaction, frustration and confusion regarding the local area’s provision for children and young people who have SEND.

Governance and the strategic leadership of the SEND reforms have not been rigorous or effective in developing a coordinated, cross-service approach to identifying, assessing and meeting the needs of children and young people. Only in recent months have leaders acknowledged that the implementation of the reforms has not been good enough. They have publicly recognised this and apologised to parents for the poor quality of delivery and slow pace in developing education, health and care (EHC) plans.

the lack of timely access to good-quality health services, particularly for speech and language therapy, occupational therapy and emotional and mental health support

the lack of advice, support and local provision for children with autism spectrum disorder and mental health difficulties

Poor communication means that many parents do not know about the local offer and lack the support they need to best help their children. Too many feel that they are driven to crisis point before additional support and advice are identified and put in place for them and their children. The timescales and processes underpinning the implementation of EHC plans are not clear to many frontline health professionals or to parents.

The local area’s approach to converting statements of special educational needs to EHC plans has been very poor. Too few have been completed and too many remain in the process of transition. Insufficient resources have been allocated to ensure that children’s and young people’s needs are identified and reassessed or that additional advice is sought when necessary. Parents report that long waiting periods, minimal assessment and a lack of communication have undermined their confidence in the process.

Referrals made to the child development centres are too often returned for additional information. This results in delays in assessment and diagnosis for children and their families. There is a backlog of referrals for autism spectrum disorder diagnosis and clinical psychology intervention. This places children, young people and their families at risk of reaching crisis point.

…services are disjointed and the roles and expectations of the various partners in the assessment and planning process are not clear. Leaders have not held staff to account for the outcomes of their work. This has led to patchy provision and the impact of services for education, health and care is limited. Parents overwhelmingly feel they have to ‘fight’ to achieve full recognition of their children’s needs.

The time taken to assess children’s and young people’s needs is concerning. EHC plans are too variable in quality. Notification of review and planning meetings to practitioners and parents is not always timely. Attendance of professionals at these events is also inconsistent.

An overwhelming number of parents report that they have to seek advice from too many different places when they need information and support for their children. There is no single point of contact to facilitate the coordination of services and the co-production of plans. This leads to inconsistencies in the identification of a child’s or young person’s needs across providers.

Too often parents say that they feel they are a burden to schools and providers because of the costs incurred in seeking external specialist support for assessing and addressing pupils’ needs. In addition, when applications for an EHC plan are turned down, there is no explanation of why this decision has been made, or any follow-up advice and support. This leaves parents, and sometimes schools, feeling unsupported and unable to meet children’s and young people’s needs.

The pathway of provision from ages 0 to 25 is not secure. Young adults and their parents and carers expressed the view that adult social care is not proactive in supporting their needs. Health professionals noted gaps in support services in the transition to adulthood phase, including in mental health services and in the provision of appropriate resources.

Some staff in universal, early years, school nursing and complex health needs services, and most staff in child and adolescent mental health services (CAMHS), have a limited understanding or experience of using EHC plans to help drive improved outcomes for children. Most child health records do not contain any copies of the plans. This is unacceptable given the time period since the implementation of the SEND reforms.

The role and contribution of CAMHS to wider partnership working are very limited. Opportunities are missed for the early identification of risk to prevent a mental health crisis, school absence or placement breakdown. Parents do not know which agency or professional is responsible for addressing the needs of school-aged children who are presenting with a combination of developmental delay and emotional, mental health and behavioural needs. The local area has acknowledged the insufficiency of provision for children and young people with autism spectrum disorder and mental health needs. Early plans are in place to start to address this.

Provision of support for children and young people with mental health difficulties out of hours is not well enough coordinated to prevent the need for admission to paediatric wards.

Therapists have a good understanding of children and young people’s requirements. However, almost all work is undertaken virtually. Local arrangements are not designed to enable a joint face-to-face, co-produced approach to meeting needs. This leads to the risk that some advice is neither appropriately understood nor used to inform a child’s plan.

The capacity of speech and language therapists, CAMHS and occupational therapists in Waveney to provide longer-term direct work is insufficient.

Because waiting times for CAMHS provision in East and West Suffolk are being closely monitored, they are starting to reduce. Close attention has been paid to the numbers waiting to be seen for longer than 12 weeks. This demonstrates necessary progress in an area that still requires significant further improvement.