NHS England is taking urgent action to improve access to specialised inpatient mental health services for children and young people after publishing a “frank and honest” report on current provision.
For England as a whole, the report says “it is impossible to conclude definitively whether the current level of bed provision is sufficient to meet the need.”
The report found that the number of NHS-funded child and adolescent mental health services (CAHMS) tier four beds increased from 844 in 1999 to 1128 in 2006, rising further to 1264 in January 2014.
But NHS England also found relative shortages in the South West and areas such as Yorkshire and Humber, resulting in patients being admitted to services a long way from home.
Alongside undersupply of beds in some areas, there was also evidence of patients being inappropriately admitted to specialised units. This was caused by a variety of reasons including gaps in CAMHS tier three services and other local health and social services provision, as well as weaknesses in commissioning and case management; Tier 4 is reliant upon the arrangements for Tiers 1, 2 and 3 which are organised at a local level.
For example, intensive outreach teams can almost halve the average length of inpatient stay, yet many areas lack them.
In response to the findings, NHS England will urgently:
- Increase general CAMHS specialised beds for young patients – there will be up to 50 new beds around the country with further beds moved according to need;
- Recruit 10 to 20 new case managers working across the country responsible for ensuring that young people receive appropriate levels of care;
- Improve the way people move in and out of specialised care; with consistent criteria for admission and discharge, based on best practice
In addition, a longer-term, strategic review of CAMHS services, will be carried out as part of NHS England’s wider work on specialised services; this will include further work with patients and their families and in partnership with other organisations.
NHS England took on commissioning responsibility for tier four CAMHS services in April 2013. Previously they were commissioned by separate commissioning organisations.
In response to concerns about people travelling long distances for care and to bring transparency to these services, NHS England carried out a mapping exercise.
NHS England’s report describes the outcome of the exercise – the first time these specialised services have been looked at nationally by one commissioner.
Dr Martin McShane, NHS England’s director for people with long term conditions, said: “Too many children and young people have had to travel some distance from their homes to access specialised inpatient beds.
“We are committed to both addressing the more immediate problems, by increasing capacity, and to improving these services longer-term, together with our national partners. We want to ensure that we can provide sustainable, high quality care as near to patients’ homes as possible.”
CAMHS Tier 4 are specialised services that provide assessment and treatment for children and young people with emotional, behavioural or mental health difficulties.
There are four tiers of care. Tiers one to three are community or outpatient-based and commissioned by clinical commissioning groups and local authorities. Tier four services treat patients with more complex needs usually requiring inpatient treatment.
Information collated during the mapping exercise will now be used to inform the longer-term review.