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Chamber and committees

Public Audit Committee

Child and Adolescent Mental Health Services follow up

Letter from Convener to Caroline Lamb, Chief Executive of NHS Scotland and Director-General for Health and Social Care, Scottish Government, 20 October 2021

Dear Caroline,

Child and Adolescent Mental Health Services

As you may be aware, the Public Audit Committee took evidence from a range of stakeholders on the provision of child and adolescent mental health services (CAMHS) in Scotland on 7 October 2021. This session was prompted by the recent publication of a blog on this issue by Audit Scotland.

The Committee was grateful to Donna Bell for attending the meeting in her capacity as co-chair of the Children and Young People's Mental Health and Wellbeing Joint Delivery Board.

The Committee found the evidence session extremely helpful in gaining an up-to-date position on how CAMHS are operating in Scotland, and the impact the Covid-19 pandemic has had on the demand for these services.

CAMHS waiting times

During the meeting, the Committee noted the significant variation in waiting times for a first appointment for CAMHS across Scotland. Indeed, the Committee heard that in NHS Fife, there are arrangements in place for primary care mental health workers to meet children and young people within two weeks. NHS Grampian report that the current waiting time for a first appointment for CAMHS is six weeks.

However, the Committee also heard evidence directly from a GP who stated that waiting times can be as long as one to two years.

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.

The Committee also noted that the Scottish Government's standard is that at least 90 per cent of children and young people should receive treatment within 18 weeks of being referred to specialist CAMHS. The Audit Scotland blog highlights however that the majority of health boards in Scotland have consistently failed to meet this target between 2018/19 and 2020/21. While the Covid-19 pandemic will have undoubtedly affected all NHS boards’ ability to meet the national target, it is evident that substantial waiting time issues existed before the pandemic began.

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.

The Committee was particularly encouraged by the improvements reported by NHS Grampian regarding its waiting times. The Committee understands that the Board attributes its improved performance to a range of factors including its centre of excellence at Aberdeen City Hospital, the delivery of its Choice and Partnership Approach as well as detailed referral guidance for GPs and increasing the number of nurse prescribers, recognising the shortage of psychiatrists, to help with patient flow.

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.

During the evidence session, the Royal College of GPs indicated that “waiting lists (in NHS Grampian) are long and parents and patients often are left to fend for themselves”. The Committee accepts that while this evidence is more anecdotal in nature, it cannot be ignored, recognising it is feedback provided by GPs working for the health board.

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”.

Additional information

During the meeting, Donna Bell kindly offered to provide the Committee with additional information on two particular areas as follows—

• 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.

• 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.

The Committee looks forward to receiving this information, alongside your response to this letter by 17 November 2021.

Yours sincerely

Richard Leonard MSP

PS As this is my first letter to you in my role as Convener of the Public Audit Committee, I look forward to working with you during this session of Parliament.