NHS England is to open up to 50 new children’s mental health beds and move some of its currently commissioned beds after an official report highlighted a lack of access to services for acutely unwell children.
The official review of tier 4 children’s mental health services found that too many children were having to travel long distances to access beds and highlighted a lack of capacity and staffing problems at inpatient services. A leading charity said the report highlighted “major failings” in the system.
Earlier this year an investigation by Community Care and BBC News revealed extensive problems with children’s mental health services. We found that children were being sent up to 275 miles for care or being admitted to adult mental health units due to problems accessing beds locally.
NHS England took on responsibility for commissioning CAMHS Tier 4 care in April 2013. Local GP commissioners retained a duty to commission community (tier 1 to 3) children’s mental health services.
The review, which was delayed by months, is described by NHS England as a “frank and honest” assessment of the system. It found:
- A shortage of beds in parts of England: A mapping exercise identified ‘under-provision’ of CAMHS units, particularly for specialisms such as under-13s care and eating disorders, in parts of the country. A sample of 100 cases provided by commissioners showed that 16% of patients had travelled over 100 miles for care, with 1% travelling over 250 miles.
- Gaps in community support: Commissioners raised concerns over reductions in the tier 3 services designed to prevent hospital admissions. Some feared that the split in commissioning responsibilities – with local CCGs retaining responsibility for tier 1 to 3 services but NHS England commissioning tier 4 services – had created a ‘perverse incentive’ for local commissioners to cut investment in community services.
- Staffing shortages: Staffing issues in services had impacted quality of care and led to units being closed to admissions. A total of 5,784 bed days were lost to ward closures during 2013. Staffing issues accounted for 1,908 of these lost days. “The lack of adequately skilled staff trained specifically in CAMHS is understood to be a problem across the country”, the report found.
- Discharge problems: A number of commissioners raised concerns over delayed discharges. In some areas this was felt particularly to relate to social care issues around support for looked-after-children.
- A lack of intensive outreach teams: Almost two-thirds (64%) of 96 CAMHS providers surveyed said they did not have an intensive outreach service. NHS England says the outreach teams “can almost halve the average length of inpatient stay”.
The report admitted it was “impossible” to say how many beds were needed to meet rising demand for care but said the staffing shortages, discharge delays and bed closures had added to the strain on inpatient units.
In response to the findings, NHS England said it will “urgently” open up to 50 new specialised beds for young patients and move further beds according to need. Up to 20 new case managers will also be recruited to work with services across the country and a longer-term strategic review of the CAMHS system carried out.
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.”
Sarah Brennan, chief executive of charity YoungMinds said: “While this review is a distressing read, we welcome its publication as it lifts the lid on a lot of major failings in the provision of children and young people’s inpatient care. This report has to be a pivotal moment where we seize the initiative and bring about a sea change in how we support children and young people’s mental health.”
Care and Support Minister, Norman Lamb, said: “I want to build a fairer society where children get the mental health care they need — but the current system is too fragmented and pressurised. To address this, we are taking immediate action by making more beds available and appointing a taskforce to improve commissioning and create more joined-up services for children and young people. I am absolutely determined to get this right so that children everywhere get high quality care.”