Children in Care: CAMHS Waiting Times

Monday 5th December 2022 Lords Chamber

Question

15:12

Asked by

[The Lord Bishop of Southwell and Nottingham]

To ask His Majesty’s Government what assessment they have made of the length of the waiting times for children and young people in care who need to access the support of Children’s Adolescent Mental Health Services; and what steps they are taking to reduce those waiting times.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We do not have a national waiting time standard for these services, so this data is not available. However, increasing access to these services is a priority. We are expanding mental health services through the NHS long-term plan. Funding for mental health services will increase by at least £2.3 billion a year by 2023-24 so that an additional 345,000 children and young people, including those in care, can access NHS-funded mental health support.

[The Lord Bishop of Southwell and Nottingham]

I thank the Minister for his Answer and declare an interest as a foster carer of more than 10 years. In my diocese, in Nottingham city and Nottinghamshire, 1,040 children and young people waited more than 12 weeks between referral and second contact last year. Surely, those delays are unacceptable. Does he agree with the president of the Association of Directors of Children’s Services, Steve Crocker, that His Majesty’s Government need urgently to undertake a full review of children’s mental health services to ensure they are able to meet the growing demand we have seen placed on them, especially for looked-after children, who are four times more likely to experience mental health issues than their peers?

[Lord Markham (Con)]

I have some personal experience in this area, so I agree that we need to see people as quickly as possible. On the investigation, we have recently undertaken a call for evidence, which closed in July with 5,000 responses that we are going through. I think that our response to that will answer many of the questions, but I would be happy to meet the right reverend Prelate and discuss this further when we have those results.

[Baroness Tyler of Enfield (LD)]

My Lords, the Select Committee looking at the Children and Families Act 2014, which I have had the honour to chair, is publishing its report tomorrow, and the frankly dire state of children’s mental health services runs through it like a stick of rock. Our inquiry received harrowing evidence of waiting times of up to two years for children already in crisis; specifically, we heard that there are very long waiting lists for post-adoption trauma support. What are the Government doing to improve mental health support for this particular group of children?

[Lord Markham (Con)]

I will need to write to the noble Baroness to give a specific response in that case. It is an area of concern where I think we are increasing awareness, and any diagnosis needs to start with awareness. By definition, that means that more people are diagnosed or come forward, which is a good thing, but it then means that often it takes longer to see those people—I do not say that as any sort of excuse but just as an explanation. As we increase our understanding in this area, and I think that we would all agree that over the last 10 to 15 years there has been a huge increase in understanding, that means that more people are coming forward, but it means also that we need up our game in terms of supporting them.

[Lord Laming (CB)]

My Lords, following the noble Baroness’s question, the Minister will well understand that children do not come into care for trivial reasons; most of them have had a very poor and traumatic start to their young lives. The state has taken on the responsibility to be a good parent to those children. Would it be possible for them to be given priority in the waiting lists for these essential mental health services?

[Lord Markham (Con)]

I would agree. In any case, especially where there is high demand in an area, we need a form of triaging so that we can agree the clearest areas of priority, such as those mentioned.

[Lord Porter of Spalding (Con)]

My Lords, my noble friend has quite rightly mentioned the amount of money that the current Government are finding to attach to this issue, and predecessors of his at the Dispatch Box would have all said similar things. The country is investing billions of pounds in children’s mental health, quite rightly—that has a huge effect on people’s lives, and it also has a huge knock-on cost to other parts of the Government’s spend if it is not done properly. What assurance can my noble friend give to the House that those billions of pounds are being spent properly on the services they are being given for, and are not being used to subsidise bad management decisions such as PFI contracts?

[Lord Markham (Con)]

I thank my noble friend. As ever, we need to make sure that every pound is well spent. These services come under the regulatory and inspection regime of the CQC. Also important in this space—probably most important of all—is understanding and getting early intervention, which means having more people in schools who understand and can help assess and identify some of those children early on. That is why the programme to intervene in schools and develop a senior mental lead is critical. Half of all secondary schools are taking that up right now. Half is not all, so there is more work to be done, but it is good progress.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, the Minister may be aware that all young people who get sentences from youth courts get CAMHS assessments, which is a good thing. However, does he think that young people who have out-of-court disposals through YOTs should also get CAMHS assessments, because a very high proportion of them would have mental health needs?

[Lord Markham (Con)]

Generally, we need to try to assess as many people as we can. I remember in my school there was a child in our class who we just thought was naughty and got into all sorts of trouble, but now, having had my own personal experience later on, I know that he had an autistic spectrum disorder. Clearly, he needed help and he was not assessed, so, as a statement, I agree that we need to increase assessment as much as we can for all these cases.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister has mentioned the provision of services in schools, which is very welcome, but does he accept that thousands of young people are now being home educated? Will he ensure that there is parallel support for those children in terms of mental health provision?

[Lord Markham (Con)]

I agree. Arguably, if you are being home schooled, you probably need a lot of help. As the noble Lord will be aware, a lot of the services are related to social prescribing, where often people with mental disorders can be helped by involving them more in community activities. Clearly, those who are home schooled are much more likely to be isolated.

[Baroness Altmann (Con)]

My Lords, I congratulate my noble friend on his previous answer about triaging so that those in care can get urgent mental health support. Does he have any targets in mind as to the proportion of children in care with mental health needs who could be seen within, let us say, six months rather than the current waiting time of up to two years?

[Lord Markham (Con)]

I thank my noble friend. The NHS has recently set out a national framework for the practical pathways that it expects ICBs to follow in terms of getting diagnoses. To be very open with my noble friend, given demand, setting targets in this space is probably not the wisest thing to do, but we understand that we need to get on top of this.

[Lord Stirrup (CB)]

My Lords, clinical staff are at crisis point throughout the NHS. What contribution are staffing levels in this area making to current waiting lists, and what is being done to address it?

[Lord Markham (Con)]

I do not know what contribution it is making to waiting lists. However, I do know that the long-awaited workforce plan—which noble Lords opposite have quite rightly asked me about many times, and I am very glad to say we are now producing it—will include these types of people as well, because they are clearly a very important component of the workforce that we need.

[Baroness Merron (Lab)]

My Lords, care-experienced children and young people are disproportionately affected not only by mental ill-health but by barriers to getting support. Bearing in mind that this group of young people often experience multiple placement moves, which are often far away from home, can the Minister say what work is going on to ensure that services are designed around this specific requirement?

[Lord Markham (Con)]

I thank the noble Baroness. As noble Lords are aware, we think that in-patient care should happen only in the most extreme and serious cases. It is much better to have care in the community and local support around that. That is very much where we are coming from. The response to the independent review of children’s social care, which the DfE is leading, will be published in the new year, and I would be happy to update the noble Baroness when we have those findings.