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Additional Information from Cabinet Secretary for Health and Social Care on priorities for coming session

Letter from Humza Yousaf on priorities for coming session - 27 September 2021

Dear Convener,

Thank you for the opportunity to update the Health, Social Care and Sport Committee on my priorities for this session. During the evidence session I committed to providing additional information in various areas. That further information is set out below:

Suitable pathways to support autistic spectrum and additional needs children and whether they are disproportionately affected by rejected CAMHS referrals.

The Children and Young People’s Mental Health and Wellbeing Joint Delivery Board agreed, and published on the 8th September, a Children and Young People’s National Neurodevelopmental Specification: Principles and Standards, which specifies for the first time the care and support that children, young people and their families can expect to receive. Scottish Government have also provided £3.06 million in 2021/22 (£5.25 million full year effect) to Health Boards to increase capacity to support the delivery of the Specification, and Scottish Government are working with Boards on their local improvement plans.

New guidance commissioned by Scottish Government, and published by the National Autism Implementation Team (NAIT), in May this year, provides complementary guidance to the National Neurodevelopmental Specification to improve assessment, formulation, recommendations, and diagnosis where important for children and young people with neurodevelopmental support needs.

The Additional Support for Learning Act places duties on education authorities to identify, provide for and review the additional support needs of their pupils. Also, autistic children and young people are supported through local Getting it Right Pathways and processes, to have needs identified early, and individualised plans in place. Support should be in place before, during and after diagnosis according to need and not simply when a diagnosis has been delivered. Our expectation is that those working directly with children and young people are able to recognise that a child may have an additional support need, through the consideration of their learning and development and will ensure the necessary support is provided.

Data split between neurodevelopmental referrals and other referrals
Public Health Scotland do not currently publish data on referrals for Neurodevelopmental assessments in general, however this may change in future with the implementation of the Neurodevelopmental Specifications. CAMHS referrals data will contain some Neurodevelopmental cases that also meet the CAMHS criteria, however is not currently broken down by pathway or diagnosis that would allow differentiation of these cases nationally. This data collection is under development, with a programme of upgrades to patient management systems that will enable this detail to be captured.

How the NHS Recovery Plan will address issues with CAMHS

On 14 September, Scottish Government announced funding of £10.83 million for the remainder in 2021/22 for Health Boards to support CAMHS improvement. This includes support for children and young people with neurodevelopmental support needs. This is part of our £120 million package of Mental Health Recovery and Renewal funding, and will support implementation of the National CAMHS Service Specification. This funding will lead to substantial improvements in the mental health care that children and young people receive in Scotland, ensuring that the right support is available in the right place, and crucially, at the right time.

It will go towards:
 establishing access to CAMHS assessments out of hours;
 access to specialist regional CAMHS services for children and young people with learning disabilities, those requiting secure care or with forensic needs;
 increasing resources to provide access to CAMHS Intensive Home Treatment Teams, and;
 supporting CAMHS liaison teams within paediatric wards.

We have committed to 10% of the annual NHS Operating Budget for mental health services, and specifically, 1% of the annual NHS Operating Budget for CAMHS.
Rejected referrals

The Scottish Government accepted all of the recommendations in the 2018 Audit of Rejected Referrals Report 2018. We have implemented a National CAMHS Service Specification, which sets out the levels of service that children, young people and families can expect from CAMHS across Scotland. This year, we have provided £47 million funding to support Boards to implement the specification. The specification includes a clear expectation that services should have appropriate re-engagement policies in place. Children and young people who are referred to CAMHS but do not meet the criteria, will receive personalised and meaningful signposting to advice, support and other appropriate services within their community. Scottish Government are working with Boards to develop improvement plans for their CAMHS services, which include assessment of how Boards are implementing the CAMHS Services Specification.

The CAMHS and Psychological Therapies National Dataset (CAPTND) was commissioned in order to collect data on the reasons why children and young people are not accepted, whether they are redirected, and if so, where they are redirected to – an action arising from the 2018 Audit of CAMHS Rejected Referrals. CAPTND was first published as an appendix in the June 2021 publication and includes a high-level analysis of accepted / not accepted referrals, however it does not describe non-acceptance reasons and actions due to currently incomplete data. Upgrades to patient management systems will be required to complete the collection, a submission outlining this work will follow. Directors of eHealth are liaising with system suppliers and embedded PHS analysts to prioritise this work as part of the £0.5m digital infrastructure, applications and data package announced in September 2021.
We are committed to improving the availability of community mental health and wellbeing services for children and young people. This year we have provided local authorities with an additional £15 Million to fund over 200 new and enhanced supports and services for 5-24 year olds. These services are expected to set up links to local CAMHS with signposting the minimum expectation and direct referral to community services the aspiration. We will continue to invest in community-based services, which provide prevention and early intervention for children and young people. Annual funding is due to double to £30 million within this parliamentary term.

The final recommendations of the Children and Young People’s Mental Health Taskforce highlighted that they may not have an immediate impact on waiting times, and could actually increase them in the short term. There are 2 key reasons for this. The Taskforce called for a greater focus on early intervention which can lead to the enhanced identification of children and young people experiencing
mental health difficulties and result in increased demand on CAMHS in the short term. The Taskforce also recommended an increase in prevention services, which by their nature will take several years before we can see the impacts of this work on waiting times.

CAMHS Waiting Times

We recognise that long waits are unacceptable, and remain committed to meet the standard that 90% of children and young people begin treatment within 18 weeks of referral. That is why we have provided £4.25m to NHS Boards this year specifically to address waiting list backlogs, and provided a programme of enhanced improvement support to those Boards with the most concerning performance. We will monitor this closely and expect all Boards to clear backlogs and meet the 90% waiting times standard by March 2023.

CAMHS improvement funding – Phase 2 of Recovery and Renewal Fund
The previous Minister for Mental Health wrote to all NHS Boards, and partners, on 24 March 2021. The letter outlined the intention to make around £40 million available to take forward dedicated packages of CAMHS improvement work, based on gap analysis undertaken as part of the implementation of the National CAMHS Services Specification.

In May 2021, Hugh McAloon, Mental Health Deputy Director, wrote to NHS Boards including details of allocations from Phase 1 of Recovery & Renewal funding of £29.15 million for CAMHS improvement. Detail provided in table 1 of attached Annex. On 14 September, we wrote to NHS Boards and Integration Joint Boards detailing allocations from Phase 2 of Recovery & Renewal funding of £10.83 million (part year effect for remainder of 2021/22) for CAMHS improvement and Neurodevelopmental support. Detail provided in the table 2 of attached Annex.

Implementation of the Women’s Health Plan

An Implementation Programme Board is being established to drive implementation of the Women’s Health Plan’s 66 actions. We are currently considering membership and remit, and will provide the Committee with further details in due course One of the priorities for the Implementation Programme Board will be to develop and publish an Implementation Plan, which will provide more detail around implementation of each action. We aim to publish the Implementation Plan by Spring 2022. We will write to the Committee with details of Implementation Programme Board membership when it has been established.

Progress of the National Digital Service

The National Digital Platform work is evolving into a collaborative and integrated approach, which pulls together infrastructure, products and services in partnership with Health and Social Care partners. A key output from this work to date is the creation and ongoing development of the National Clinical Data Store (NCDS), which is the single point of truth for all C-19 vaccination data. NCDS links to other digital products including the Turas Vaccination Management Tool (VMT), GP-IT, PHS and CHI. These core systems being interoperable are now allowing us to realise our ambitions of ensuring that information is available to staff when and where they need it. This collaborative and integrated approach pulls together the infrastructure, products and services which, together represents an evolution in how health and care technology is delivered, managed and experienced in Scotland. The refreshed Digital Health & Care Strategy, scheduled to be published shortly, will set out the key areas of focus for the NDP going forward.

European countries who have introduced vaccination certification schemes
As I noted at the meeting, several Governments in countries across Europe are using Covid status certificates, including Austria, Belgium, France, Germany, Ireland, Italy, Netherlands and Norway.

It should be noted that many countries have already gone much further than the Scottish Government is proposing. The overall impact of their schemes, and in particular vaccine uptake, depend on a wide range of factors including but not limited to the number or nature of the sectors covered by the certification scheme and the level of vaccine uptake in a specific country prior to the announcement of introduction of a certification scheme.

I trust this is helpful and look forward to continued engagement with the Health, Social Care and Sport Committee throughout the session.

Table 2 - Allocations from Phase 2 of Recovery & Renewal funding of £10.83 million (part year effect for remainder of 2021/22) for CAMHS improvement and Neurodevelopmental support