Other issues
Services for looked after children
We are aware of past cases where there have been disputes between NHS Boards about responsibility for providing CAMH services to looked after children and young people who are accommodated outwith their home area . We therefore asked some questions about provision for looked after children and young people at the CAMH service meetings.
We found that in each NHS Board area there have been developments in providing services to looked-after children and some form of dedicated service is now in place. This can range from a fully dedicated multi-disciplinary team to services which provide consultation and advice or training to carers working with looked after children. CAMH services though are concerned about the equity of provision for children and young people who are accommodated outwith their home NHS Board and local authority areas. It was clear from discussions about this issue that approaches to providing services to this group vary widely across the country. This is in spite of the fact that guidance was published in March 2004 which set out procedures for establishing the responsible commissioner for an individual's care within the NHS (NHS HDL (2004)15: Guidance on Establishing the responsible Commissioner). This guidance clearly says no treatment should be refused or delayed due to uncertainty or ambiguity over who is responsible for funding an individual's health care. It includes a specific section on looked after children, again emphasising that any changes in health care commissioning responsibilities must not be allowed to disrupt the provision of timely care and treatment. We are concerned that, based on those individual cases we have been made aware of and discussions with CAMH services across Scotland, looked- after and accommodated young people may not be receiving timely access to care and treatment.
Services for people who self harm
In all NHS Board areas we found a focus on developing services for young people who self harm. We heard about several Choose Life initiatives, about the development of local protocols and about areas where very positive links with primary care have been established. One common theme was the need in many areas to ensure that accident and emergency staff are aware of local protocols so they can make appropriate referrals to CAMHS when a young person has been seen at A&E.
Service development plans
We were advised at each of our meetings with CAMH services that very detailed service development plans are now in place.These plans identify gaps in service provision and contain proposals for enhancing the specialist services. We received copies of these plans either before or at the meetings arranged. There is obviously a very significant issue about how resources will be allocated to implement these service development plans, many of which will be based on the recommendations of the 2005 framework report.
Notification of admission of children or young people to non-specialist wards
It was clear in discussion at the CAMH meetings that the MWC may not be receiving all the notifications we expect to get, when a young person is admitted to a non-specialist in-patient unit. It was also clear that on occasions some general adult psychiatristsare under the impression that the MWC has issued guidance to say that no young person under 18 should be admitted to a non-specialist unit.
Recommendations
NHS Boards must ensure that looked after and accommodated young people placed outwith their home health board and local authority areas receive CAMHS input whenever this is necessary.
The MWC will revise and re-issue our guidance re admissions to non-specialist wards, and notifications; review monitoring information we request; and review how we undertake our monitoring duties generally as they relate to children and young people.
