What has happened to CAMHS?

If you attempted to telephone your local Child and Adolescent Mental Health Service (CAMHS) in the first weeks of September, in Broadstairs or Canterbury, or anywhere else in Kent or Medway, you will have been greeted by a monotonous tone signalling that the telephone line had been disconnected. No-one was warned about this; not the patients, families, GPs or other professionals, or even the staff who work in these clinics. The reason the phones were disconnected was because the management of Kent CAMHS services migrated from its former provider, Sussex Partnership Foundation Trust (SPFT) to the new provider, North East London Foundation Trust (NELFT) on 1st September 2017. As well as the telephone lines being disconnected, the electronic patient record system shut down, pending referrals were closed, and staff email accounts were disbanded. CAMHS, as you know it, was effectively cut off. SPFT had been responsible for Kent CAMHS services for the past four years since they successfully won the tender from East Kent Hospitals Trust (EKHT). One can only assume that the tender, like any other, was won on a ‘provide more for less’ basis. SPFT’s head offices are in Swandean and Arundel; hours away from the Kent services they were commissioned to provide. The tender brought uncertainty for clinical and admin staff including restructuring, redundancies and reapplications for jobs with obvious implications for patients and families – all at financial cost to the NHS. It also meant a massive rebranding of everything from letter heads to the signage outside every single clinic. There were new mobile and desktop telephones, laptops and ipads for all staff as well as new paper and electronic patient record systems.  As well as new contracts for buildings maintenance, IT support, heating, lighting, telephones, even alarms – all at a financial cost to the NHS. The initial tender was for three years and so from about 18 months in, senior and middle managers became embroiled in writing a new tender bid, travelling by car, with expenses paid in addition to their salaries, to meetings in Sussex; a tender they ultimately lost –  all at financial cost to the NHS. There was also a cost to staff and to patients and families who moved further and further down on managers’ lists of priorities as the deadline for tender grew closer. On 1st September, NHS Clinical Commissioning Groups (CCGs) and Kent Local Authorities awarded the new tender to NELFT. Staff were issued with brand new mobile and desktop telephones as well as desktop and laptop computers – a further financial cost to the NHS. There was another new electronic patient record system to be trained in; two days’ worth of training for every clinical and admin staff member, as well as additional training in health and safety and the obligatory Meet and Greet with lunch provided – a further financial cost to the NHS.  NELFT’s mission is to deliver an ‘easily accessible, emotional wellbeing and mental health service to children and young people’*. CAMHS tier 2 and tier 3 services in Kent and Medway no longer exist. Let’s be clear here; they no longer exist. In Kent the new service is Children and Young People Mental Health Service (CYPMHS) while in Medway it is the Young People’s Wellbeing Service (YPWS). NELFT were also chosen to develop and deliver an all-age eating disorders service (AAEDS) across Kent and Medway. Again, a tender won, one assumes, on a promise to provide more for less. These new services are currently in a period of consultation. Uncertainty around what they will look like in reality is set to continue until this period ends on 1st April 2018. The consultation period has been billed as ‘business as usual’ by managers but anyone trying to access the services or work within them will know that this is not the case at all. Chaos and confusion reign. Staff and union representatives have been provided with the consultation document which reiterates that NELFT ‘are not consulting on what will be delivered as this is pre-determined’*. In January 2018 staff began the process of re-applying for jobs; either their own or a de-banding because, in reality, there aren’t enough clinical or admin roles to go round. There are no receptionist roles at all. Staff will face a choice between agreeing to relocate anywhere across the county, accept a demotion or resign. Many are opting for the latter in a bid to avoid going down with the sinking ship. One of the criticisms of CAMHS, as it was, was high referral criteria and long waiting lists. NELFT’s response to this is Single Point of Access (SPA). There is a Kent SPA based in Maidstone and a Medway SPA in Chatham that take referrals from anyone, including self-referrals from patients aged 0 – 19 years and their families. SPA is commissioned to receive, screen and direct referrals as well as provide advice, information, consultation and support to referrers and other services; that’s a big ask. The idea behind the model is to ‘allow more children and young people to obtain better help and support sooner’*. The previous CAMHS service, which was under-staffed and under-funded, failed to meet the mental health needs of young people in Kent. The new service promises to do much more for much less. It’s not working; SPA currently has a backlog of almost 500 referrals waiting to be triaged in East Kent. Once triaged, these patients will enter the system and be signposted out or sit on internal waiting lists for treatment. The new service will consist of five care pathways*. These are:
  • Early help pathway
  • Behavioural and conduct pathway
  • Neurodevelopmental and learning disability pathway
  • Mood and anxiety pathway
  • Complex pathway
The specialist learning disabilities and challenging behaviour (LDCB) and children in care (CiC) teams that sat within CAMHS will be disbanded. To reiterate, tier 2 and tier 3 CAMHS no longer exist. The five care pathways will be led by band 7 clinicians, who will act like (but not be remunerated as) managers. The care pathway services will be provided by multi-disciplinary pathway workers employed at band 6 and mental health workers employed at band 5. To bastardise an old adage; you pay peanuts; you get CYPMHS. Name and address withheld *Quotes and CYPMHS structure taken from the Consultation document *Proposed posts
Position Band Canterbury full time equivalent Thanet full time equivalent 
Consultant Psychiatrist Consultant 1.20 2.00
Trainee Doctor CT2 0 1.00
Senior Clinical Psychologist or Psychotherapist 8b 1.00 1.00
Integrated Team Manager 8a 1.00 1.00
Clinical Psychologist/ Family Therapist/ Psychotherapist 8a 1.20 1.80
Pathways leads 7 5.00 5.00
Youth Offending Worker 6 1.00 1.00
Multi-disciplinary Pathway Worker 6 5.50 6.50
Mental Health Worker 5 1.00 1.50
Medical Secretary 4 0.50 1.50
Assistant Psychologist 4 2.50 3.00
Administrator 3 2.50 3.00
Total full time equivalent staff 22.4 28.3
 

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