NHS children’s services targets ‘too ambitious to hit’

Child and adolescent mental health services are falling short of key indicators, despite recent progress.  Simeon Brody reports

A leaked government letter revealed last week that the NHS would fail to meet a key target to deliver a comprehensive child and adolescent mental health service in England by 2007.

The letter from Richard Gleave, the Department of Health’s senior performance management official, to strategic health authority chief executives, made clear they were “not on track” to meet the three performance indicators that make up the target.

Just 162 of the 302 primary care trusts in England are able to provide a dedicated Camhs for children with learning difficulties, the letter says. Only 224 are providing a service for 16- and 17-year-olds and just 249 provide a 24-hour emergency Camhs.

Performance against the indicators varies markedly around the country. The PCTs in what was the South East London Strategic Health Authority have met all the targets – boundaries have since changed so the whole of the capital is now covered by one authority – while in Cumbria and Lancashire only 36 per cent of the indicators have been met.

Young Minds training and consultancy manager Lee Miller says Camhs provision is struggling as NHS money is reallocated.
Worse, PCTs have yet to receive Department of Health Camhs money for this financial year, leaving commissioners unsure about whether to maintain services or plan for redundancies.

But a Department of Health spokesperson says “dramatic improvements” have been made in a short time. Since last year the number of PCTs commissioning services for children with learning difficulties has increased by a quarter and £300m has been invested in Camhs in the past three years.

Miller says there has been progress but the targets may have been too ambitious.

Sue Bailey, registrar of the Royal College of Psychiatrists, agrees. She says delivering the learning difficulties target would require training mental health workers in learning difficulties work or vice versa. But staff would need to be taken out of projects to train and new services set up. Similarly, 24-hour services started at a low base, particularly in rural areas in the North West.

And creating dedicated services for 16- and 17-year-olds has been made more difficult because of pressure on bed places.

Bailey and Miller argue that, in focusing on the three elements of the target, other mental health services, such as those for looked-after children or young people in prison, may be overlooked.

But some areas, including Southwark, in London, are likely to meet all the targets this year. The borough’s joint commissioner for Camhs, Ragnhild Banton, says it has been fortunate in the level of its grant – about £1.8m. She says her role as a joint commissioner, managing the Camhs funds that are paid separately to Southwark Council and Southwark PCT, has been crucial in getting health and social care to work together.

And she adds that increased commissioning from the voluntary sector has been crucial to Southwark’s success. Ten per cent of its local authority grant has been spent on five voluntary sector contracts, offering early and less stigmatising responses.


Additional reading
Child and adolescent mental health: special report

Further information
Young Minds
Royal College of Psychiatrists