Venue: Remote Meeting
Contact: Josef Galkowski 01952 388356
Declarations of Interest
Minutes of the Previous Meeting
The Chair reported that the minutes of the meetings held on 22 October 2021 and 19 November 2021 would be presented for approval at the next meeting.
To consider a report from David Evans, Joint Accountable Officer for Shropshire and Telford & Wrekin Clinical Commissioning Groups.
The Chair welcomed David Evans, Chief Officer Shropshire and Telford and Wrekin CCGs to the meeting.
Mr Evans provided the background to the transformation around the CAMHS Service three years previously and the reasons for it. The service was now predominantly delivered by MPFT and covered an age range of 0 – 25 which allowed for a good transition from children’s services into adult services. The aim was to provide as good a quality service as possible that intervened early when mental health started to cause concern to prevent the risk of escalation.
Members and participants in the meeting made a number of observations and asked questions to which Mr Evans responded:
What happens to a young person if they are referred into the service at around the age of 18?
An 18 year old would normally be referred directly into adult mental health services. The idea of the BeeU 0 – 25 service was to facilitate a gentle transition from one team to another for those who were already receiving support.
Would tier 4 count as the ‘getting more help’ step or ‘intensive help’?
Tier 4 represented intensive help – this was very specialist support commissioned by NHS England, not the CCG, there were no tier 4 beds locally.
There are currently children in hospital at the moment with mental health conditions – would two be the normal number? Do children arriving at A&E because of a mental health issue usually known to the service already?
It is unusual to have two children in hospital at the same time. Children with mental health conditions sometimes present at A&E if they reach a crisis point.
Who can refer into the system and who would progress the child onto the next step if additional support is needed?
A GP, social worker, or someone in education would normally make an initial referral. The level of support required would be determined by the BeeU service which would also determine when that level of support needed to change.
Can parents/carers refer into service?
The normal referral route was through a school or GP, but if the child was already in the service and there was parental concern about deterioration then the service could be contacted directly.
Getting help is a time limited service – was there a possibility that a young person could be returned back to the very start of a referral process once they were in it?
That would only occur if a child was discharged from the service completely, but a child was likely to be seen directly if parent/carers concerned about deterioration.
The Chair invited Zara Bowden from Shropshire Parent and Carer Council to speak. She raised a number of issues around the referral system, and the quality of the information considered at triage. Parents had described GP referrals being sent back with a request that the referral be instead made by a school. However, in order for a school to make a referral, the child needed to ... view the full minutes text for item JHOSC7
Accident and Emergency
To receive a brief update from David Evans, Shropshire and Telford & Wrekin Clinical Commissioning Groups regarding admission and treatment rates at the RSH and PRH accident and emergency departments.
David Evans provided an update on A&E activity as requested by the Committee. The trend overall for Shropshire and Telford and Wrekin patients was below that of 2019 activity - at PRH 25% lower and at RSH about 5% lower. During October 2020 120 patients had been admitted from A&E at PRH, in October 2019 this had been 160. At RSH 130 patients had been admitted from A&E in October 2019 but this had increased to 145 in October 2020. Arrivals at PRH by ambulance had decreased by about 10 – 15% and walk ins were much lower. At RSH ambulance attendance has increased slightly since June but walk in attendances were slightly lower.
Responding to questions on the reasons for the differences between the two sites, he said this was partly due to age profile of the population and partly related to complexity of case mix as emergency surgery was carried out at RSH. There had been increasing activity levels over the last 10 days and it was expected that this increase would continue with covid and winter pressures combined.
SATH and Shropshire Community Health Trust both currently had as many patients with Covid as they had back in April. There were however less patients in ITU although more on oxygen therapy overall.
A member drew attention to a recent long delay for an ambulance to arrive the south of the county. Mr Evans reported that the ambulance service was under a lot of pressure, particularly when large numbers of ambulances arrived at A&E at one time and there were long waits to offload patients.
Members asked if measures taken to address covid, such as social distancing and wearing of masks might help to alleviate normal winter pressures. It was hoped that this might be the case but patients did seem to be sicker and putting more strain on services, particularly at RSH.
The Committee thanked Mr Evans for the update and said they would welcome another update in approximately six months time.
The Committee agreed that more work on children’s mental health would be undertaken next year particularly to follow up on progress in addressing the issues raised at the meeting, and also around transition.
A Member felt that there were questions around covid which needed to be asked and she was encouraged to circulate her thoughts to all members for informal discussion in the first instance.