Agenda item

To receive a report from CNWL on mental health provision in Westminster.

8.1       The Committee received a report from CNWL NHS Foundation Trust, focusing on mental health provision in Westminster. The Committee noted that mental health services for provision for children and adolescents had been included in this report for a comprehensive survey of the mental healthcare landscape, though health issues relating to children and adolescents came within the remit of the Business and Children’s Policy and Scrutiny Committee.

8.2     The Committee asked about waiting times for mental health care and therapy services in Westminster, especially for the Woodfield Trauma Service. The Committee was advised that, though long waiting times were recognised, they were at times deliberate, and discussed with patients, where time was needed to prepare mentally for receiving therapeutic treatment. The Committee was pleased to hear that one of the aspirations of CNWL was to stay in contact with patients on waiting lists, to make certain that they were aware and updated about any changes.

8.3    The Committee also heard from Jackie Shaw, Service Director for CAMHS, Central and North West London NHS Foundation Trust. Jackie Shaw explained to the Committee that during the pandemic, more children and young people had presented as potentially autistic, leading to longer waiting times for assessments.

8.4       The Committee observed firmly that the listed waiting time for Autism Diagnostic Observation Schedule (ADOS) assessments in Westminster (currently ten months) was far too long. The Committee was informed that additional investment in assessments for autism had been secured in order to assist the service in training more staff and catching up. In addition, the Committee heard that, where a full ADOS assessment was not necessary, other forms of assessment had been implemented. The Committee discussed an ideal waiting time of 24 weeks as the timeframe that CNWL had been given by Commissioners. The Committee heard that measures to achieve this waiting time included a recruitment drive, an effort to give staff access to relevant training, and improving staff working conditions to drive efficiency.

8.5       The Committee had requested clarity on standard waiting times for different categories of mental health care provision. The Committee was advised that ‘emergency’ cases received a response within four hours, which was a standard met in almost 100% of cases. The Committee was advised that ‘urgent’ cases were responded to within 24 hours and that ‘routine’ response times were 27 days. The Committee was further advised that patients were allocated to these categories on a case-by-case basis based on the severity of crisis experienced, and their level of distress, either self-reported or as assessed by a member of the first response team. The Committee heard that a policy of ‘no wrong door’ had been implemented, meaning that whichever method patients used to access services, they would be directed holistically to the correct provider, specialist, or therapist.

8.6      The Committee asked for more information about Kooth, an online counselling service commissioned by North-West London commissioning group. The Committee heard that therapists accessed through Kooth were all qualified practitioners and that Kooth was aimed at making mental health services accessible to users up to 25 years old, having seen success in the past engaging with young men and groups that did not engage readily with primary care. The Committee also heard that the Kooth confidential service provided advice, direction or signposting towards local services, and counselling via telephone.

8.7    The Committee queried the approach taken with rough sleepers and was pleased to hear that a joined-up approach was being adopted towards rough sleepers, many of whom were struggling with substance dependencies. The Committee heard that consistent work was being undertaken to engage with rough sleepers so that they did not disappear from the radar of CNWL.

8.8      The Committee requested the publicly available performance reports across all of the CNWL service areas, so that it would be clear how well the services were performing against their targets. The Committee observed that the CAMHS data included in the report was useful to the Committee, and requested further detail and rigorous data examination across the board.

8.9     The Committee asked where children and young people were able to go if they required in-patient care and would only be safe in a residential care environment. The Committee heard that CNWL was the provider for two wards that fitted this description within the North West London area: Collingham Child and Family Centre, a longstanding unit offering 12 beds for children under 13 years of age, and also Lavender Walk, an in-patient adolescent unit, also offering 12 beds. Jackie Shaw advised that there was no provision within the borough boundaries of Westminster at present. 

8.10    The Committee was advised that the most frequent diagnoses seen in children and young people in Westminster were eating disorders, self-harming, and psychosis. Jackie Shaw informed the Committee that depression and anxiety were now frequently being picked up by CNWL’s at-home treatment service, in cases where families could keep children safe at home.

8.11     The Committee expressed concern for CNWL staff, noting the possibility of burnout due to the intensity of work required of them. An anonymous letter to Councillors from a member of CNWL staff described conditions as extremely stressful and unhealthy. CNWL committed to responding to the letter. The Committee was pleased to hear that measures are being taken to support staff given the pressures that staff are under, including resilience sessions, breakout areas to provide space, and reporting systems to communicate difficulties upward without risk to staff.

8.12    ACTIONS:

1) The Chairman requested that NHS monthly performance data be shared with the Committee, and added as a standing item for future meetings.

2) The Chairman requested that data around Emergency, Urgent, and Routine assessments be submitted to the Committee on a quarterly basis.