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Child and Adolescent Mental Health Services: Follow up by the Scottish Government

Letter to Convener from Caroline Lamb, Chief Executive of NHS Scotland and Director-General for Health and Social Care, Scottish Government, November 2021

Dear Convener

Child and Adolescent Mental Health Services (CAMHS)

Thank you for your letter of 20 October 2021. I very much appreciate the Committee’s consideration of this important work. I would like to reassure the Committee that the mental health and wellbeing of children and young people is an absolute priority for the Scottish Government. For this reason, the Programme for Government commits to ensuring that at least 10% of frontline health spending will be dedicated to mental health by the end of this parliament and at least 1% will be directed specifically to services for children and young people.

I am glad the Committee found the session helpful and hope you find the information set out below helpful in relation to the points that you have highlighted.

As discussed at Committee, the Children and Young People’s Mental Health and Wellbeing Joint Delivery Board is overseeing a set of reforms designed to ensure children and young people receive the support they need, when they need it. The Board will continue to ensure the development of a coherent, whole system approach with a focus on the pathways and journeys that children, young people and their families may take. The voices and experiences of children, young people and their families is central to this work. Further information and progress of the Joint Delivery Board can be found here. The Board is producing quarterly newsletters which we would be happy to share with the Committee Clerk.

I will now respond to the points as they have been raised in the letter:

CAMHS waiting times

“The Committee would therefore be grateful for your views on the reasons for this extremely concerning variation in waiting times, recognising your role in driving performance, efficiency, value for money and the delivery of sustainable safe, effective and person-centred services across the NHS in Scotland.”

We acknowledge that, despite increased investment in the CAMHS workforce over recent years, the waiting times standard was not being met by most Boards pre-Covid-19, and there was unacceptable variation between, and within, Health Boards in the length of time that children and young people were having to wait.

That is why, in the months before the pandemic, the Scottish Government had already begun to explore the reasons for this variation and to deliver a programme of enhanced support to those Boards with the most concerning performance. Unfortunately, this work had to be paused during the first wave of the Covid-19 pandemic, when the focus turned to ensuring that Mental Health services continued to operate and were available for the most urgent cases.

This work was restarted last autumn, with a tailored programme of enhanced improvement support for seven NHS Boards in which the waiting times for treatment were unacceptably long (NHS Borders, Fife, Forth Valley, Highland, Lanarkshire, Lothian and Tayside). We have been working with Mental Health leads in these Boards to support the development and implementation of local recovery plans and to target investment to improve access to CAMHS and Psychological Therapies. This involved: reviewing their existing recovery plans; analysing performance and capacity data; ensuring the development of modelling and trajectories; and advising on actions to take.

These Boards submitted local improvement plans in July 2021, setting out how they will meet the standard and eliminate long waits by end March 2023. We provided each of these Boards with feedback on their plans, and will continue to monitor this closely and expect all Boards to meet the 90% waiting times standard.

“The Committee would also welcome your views on why there has been such a consistently poor picture of performance in meeting the Scottish Government standard, which clearly pre-date the Covid-19 pandemic.

In providing your response, the Committee would be keen to establish the extent to which you are confident that the wide-ranging work being undertaken by the Scottish Government to support children and young people with their mental health will result in reduced waiting times across Scotland.”

We absolutely agree that further change is still required to enhance the support available to children and young people. The pandemic has undoubtedly had a negative impact on many children and young people. Ensuring there is sufficient focus and investment in mental health across Scotland is key. Accelerating improvements to CAMHS is an important part of our response. As highlighted in the Audit Scotland blog, the Scottish Government has already invested around £40 million of the new Mental Health Recovery & Renewal Fund in 2021/22 which will:

• Begin to address CAMHS waiting times with a view to all Boards eliminating backlogs and meeting performance standards by March 2023. Children and young people whose referral is not accepted should be sensitively and appropriately signposted to a more suitable service within their community.
• Support implementation of the National CAMHS Service Specification, which sets out the levels of service that children, young people and families can expect from CAMHS across Scotland.
• Improve community CAMHS, with an expansion from age 18 to age 25 for targeted groups, and those who wish it.
•  Provide access to out of hours assessments, intensive and specialist CAMHS services, which will benefit children and young people with complex needs, and their families, including in a home setting.

In addition, we have provided £15 million additional funding to local authorities to deliver locally based mental health and wellbeing support for 5-24 year olds in their communities this year. Over 200 new services and supports have been established to date. These new services are linking up with CAMHS to ensure signposting and referral routes are in place so that children, young people and their families can access local support. These services offer an alternative for children and young people for whom CAMHS is not appropriate, by providing support for emotional distress delivered in a community setting.

We fully anticipate a similar level of additional investment in both CAMHS services and community support in 22/23 to ensure progress is maintained. Whilst there will undoubtedly be challenges for delivery partners in taking forward these improvements (for example, workforce recruitment and retention), we believe the significant investment in and focus on mental health will bring significant benefits to children and young people across Scotland.

This investment is backed up by the programme of enhanced improvement support in seven Health Board areas, mentioned above, where waits are unacceptably long. It is vital that we get this right and developing a support programme to enable the implementation of the CAMHS Service Specification is just one of the deliverables being taken forward by the Children and Young People’s Mental Health and Wellbeing Joint Delivery Board.

The Committee will also wish to note that on 8 September, the Scottish Government published the National Neurodevelopmental Specification for Children and Young People: Principles and Standards of Care which sets out seven standards for service providers to ensure that children and young people who have neurodevelopmental profiles with support needs, receive further support than is currently available. These children and young people are often referred to CAMHS but do not always meet the mental health criteria described in the National CAMHS Service Specification criteria.

The Neurodevelopmental Specification aims to ensure that children and families receive the support and access to services that meet their needs at the earliest opportunity, based on the Getting It Right For Every Child (GIRFEC) approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. As part of this year’s investment through the Recovery & Renewal Fund, specifically £3.06 million has been allocated to NHS Boards for the remainder of 2021/22 to build capacity to provide access to specialist neurodevelopmental professionals to support the implementation of the Neurodevelopmental Specification.

In addition, through the Joint Delivery Board’s Neurodevelopmental Task and Finish Group, we are establishing a number of Tests of Change to explore implementation of aspects of the Neurodevelopmental Specification across local areas. These Tests of Change will provide learning and evaluation of implementation to be shared across Scotland to support the national implementation of the Specification.

“The Committee is keen to establish what work the Scottish Government is leading to share and promote any good practice that can be learned from NHS Grampian to improve CAMHS more widely across Scotland.

The Committee therefore wishes to establish your views on the apparent discrepancy between the quantitative data reported by NHS Grampian and the qualitative evidence from GPs working “at the coal face”.

We are extremely pleased to note the improvements to CAMHS waiting times that have been achieved in NHS Grampian and are keen that this learning is shared with other Boards. NHS Grampian benefitted from the use of the Choice and Partnership Approach (CAPA) and external advisors based in Healthcare Improvement Scotland (HIS) to improve their performance. To ensure this learning and approach is shared, we have commissioned Dr Ann York, co-author of CAPA, to provide CAPA masterclasses and advice to Boards using CAPA as part of our enhanced support arrangements to seven Boards. In addition, we have recently established a Scottish Benchmarking and Quality Network to pull together comparable evidence about our services across Scotland and encourage the sharing of best practice. We have also held several networking sessions for Mental Health leads across Scotland, the most recent of which was chaired by the Minister for Mental Wellbeing and Social Care and focused on sharing solutions to Systems Pressures across Scotland.

We recognise that sometimes, the experiences of individual professionals on the front line will differ from Scottish Government policy intention or from statistical publications. I would like to reassure you that while statistics and performance data are one measure of improvement, we also take very seriously the feedback of all those working to deliver front line services, as well as the views and experiences of children, young people and their families. We will consider all measures holistically, and will raise the feedback provided by GPs with NHS Lothian.

Additional information

Donna Bell, Director of Mental Health and Social Care offered to provide the Committee with additional information including:

• “A breakdown of the actions that have been taken against each of the 29 recommendations made by the Scottish Association for Mental Health and NHS NSS Information Services Division in its “Rejected referrals to child and adolescent mental health services audit”, published in 2018.”

An update on the each of the recommendations from the Audit of
Rejected Referrals can be found at

Annex A.

• “Detailed information on work the Scottish Government is progressing with Public Health Scotland to improve the quality and scope of data on the provision of mental health services for children and young people. The Committee would be most grateful if this information could include how this work will provide reassurances that public funds are being spent wisely in this area.”

Public Health Scotland published a first tranche of data from the patient-level CAMHS and Psychological Therapies National Dataset (CAPTND) alongside the waiting times publications on 1 June, and a second including an analysis of accepted referrals by SIMD, age and sex on 7 September. The Scottish Government commissioned a programme to identify upgrades to local patient management systems that will enable the completion of CAPTND on 14 September. Furthermore, PHS are implementing the data requirements arising from the CAMHS Service Specifications, which will enable the monitoring of implementation and funds spent on improving mental health services for children and young people.

Counsellors in schools

At the roundtable discussion, Hannah Axon, COSLA, mentioned that the first report into Counsellors in Schools has now been published and can be found here.

Finally, we welcome the Inquiry into the Health and Wellbeing of Children and Young People announced by the Health, Social Care and Sport Committee earlier this month and look forward to continuing to report progress to Parliament on this key priority. If you require any further information please do not hesitate to get in touch. I very much look forward to working with you in this Parliamentary session.

Kind regards,

Caroline Lamb