Royal Manchester Children’s Hospital Child and Adolescent Mental Health Service (CAMHS), part of Central Manchester University Hospitals Foundation NHS Trust (CMFT) is a complex service providing both a district based service to NHS Manchester and NHS Salford, and also more specialised tier 4 CAMHS provision to the north-west region.
Royal Manchester Children’s Hospital Child and Adolescent Mental Health Service (CAMHS), part of Central Manchester University Hospitals Foundation NHS Trust (CMFT) is a complex service providing both a district based service to NHS Manchester and NHS Salford, and also more specialised tier 4 CAMHS provision to the north-west region. CAMHS community services are currently provided by four locality teams, including targeted teams (learning disability, looked-after children, youth justice, and child and parent teams), a dedicated 16-17 team, regional provision (including an outreach eating disorder team) and a psychosocial liaison team.
Their catchment area includes areas of high socio-economic deprivation with associated high predicted rates of mental health difficulty. With the aim of providing high quality, seamless and coordinated care, Manchester and Salford have developed integrated joint access pathways for health, social care and community and voluntary sector providers. The service also has established links with research and academic institutions, and participate in NHS England’s Schools Link project, to develop closer links between children and young people’s mental health services and schools.
Developing integrated care pathways
Manchester and Salford CAMHS is currently undertaking a programme of transformational change and improvement. This has enabled a recognition that an integral part of success in meeting performance targets and providing safe, effective and timely care, is by services being delivered via streamlined integrated care, which incorporates a multi-disciplinary/agency teamwork approach. There is a wealth of evidence to demonstrate how Integrated Care Pathways (ICP’s) provide opportunities for sustained quality improvement in the delivery of care services. ICP’s come under the umbrella of ‘Structured Care Methodologies’ and are a way of managing, monitoring and recording an episode of care. Essentially, an ICP is a statement of anticipated care placed in an appropriate time frame, written and agreed with the child or young person, and their family or carers, and a multidisciplinary/multiagency team.
It was recognised that assessments within the CAMHS service lacked consistency across localities, with children and young people often staying in services beyond an acceptable time scale, without receiving timely interventions. Considering this, CAMHS staff embarked upon a number of intense pieces of work in order to improve service provision and patient experience. The development of Integrated Care Pathways emerged as a vital requirement to most other work streams. The pathways acknowledge recent Department of Health recommendations including ‘Future in Mind’ and ‘The Thrive Model’ and promote a service developed, delivered and shared by young people and clinicians.
Pathways currently in development include:
- an integrated joint referral to access pathway for health, social care and voluntary and community sector organisations
- an assessment pathway utilising an evidence based model to ensure patient choice, collaboration and integrated working
- difficulty and disorder specific pathways
- district and specialist paediatric service pathways, including pathways for referral and access, assessment, individual and group therapy, palliative care and interventions for paediatric diabetes.
Evaluating the pathways
On completion, the ICP’s will be tested via small scale pilots, adjusted as necessary and then circulated to the CAMHS CSU Strategy and Effectiveness Group for final sign off and implementation across CAMHS services and the wider health and social care economy. The small scale pilots will include feedback from young people and families. The ICP’s will then be made available to professionals in other service areas or Trusts as a resource to support service development. The CQC rated CMFT’s provision of children and young people’s mental health services as outstanding in 2016.
Benefits of delivering integrated care pathways
- Clearly defined plan and duration of care for the child, young person and their family and carers.
- A collaborative approach from admission to discharge that incorporates the child, young person and their family and carers’ views on what is the right service for them at that time. This may not always be CAMHS.
- Goal and outcome focused
- Improved communication between professionals and agencies – at any point in time it is clear where care is in relation to meeting the shared goal.
- Demonstrates evidence based best practice
- Defensible practice
- Auditable process of care
- Dynamic document that can be adapted and revised to incorporate service and practice developments
- Improved access and no waiting times for CAMHS assessment when families and young people have mental health needs identified within other agencies
- A smooth journey between agencies with a promotion of multi-agency working to aid continuing engagement, understanding and recovery.
|Commissioning||Manchester and Salford CCG and Manchester and Salford Council|
|Providers||Central Manchester University Hospitals NHS Foundation Trust, 42nd Street, YASP (Manchester Mind), Kooth, Place2Be, Salford Royal NHS Foundation Trust|
|Workforce (whole-time equivalent)||Employed by CMFT – 12 psychiatrists, 53.6 clinical psychologists (band 7, 8a, 8b, 8c and 8d), 2.2 psychology assistants (band 4 and 5), 2.6 psychotherapists (band 7, 8a and 8c), 2 family therapists (8a), 2 children’s nurses (band 7), 4.8 learning disabilities nurses (band 6); 43.2 mental health nurses (band 5, 6 and 7), 9 healthcare assistants (band 2); 3 teachers, 2 dieticians (band 7), 1.4 occupational therapists (band 7), 0.6 physiotherapist, 3 speech and language therapists (band 6), 7 social workers (4 band), 4 service managers (8a), 1 data manager (band 4) 1 general manager (band 8c), 28.3 admin staff (band 2 to 4) and 4.41 office managers (band 5).|
|Population size||Manchester – 2.5 million, Salford – 218,000 (all ages)|
|Caseload||Across the pathway, over 7000 referrals were received and almost 17,000 contacts conducted.|
|Prevention and resilience – universal and early intervention for at risk||Specific specialist assessments e.g. ADHD||In-reach, inpatient and residential|
|Access and advice – consultation lines, triage and signposting||Scheduled care||Crisis|
|Early support and brief interventions||National and regional interventions|
|Biopsychosocial assessment||Intensive interventions||