• Commissioners in south Staffordshire admitted their autism services were “not fit for purpose”
  • But letters suggest there was subsequently “minimal” oversight of the service, due to its size
  • Families have raised concerns over service since 2013 

Serious safety concerns over a children’s autism service went unaddressed for at least two years, despite an admission from commissioners that the services were “not fit for purpose”.

The problems in south Staffordshire were acknowledged by clinical commissioning group leaders in 2016, following multiple complaints from families. But letters seen by HSJ suggest the level of subsequent monitoring and intervention over the next three years was “minimal”.

After continued concerns being raised by families, the lead CCG commissioned an independent review of the service in 2018, details of which were leaked to The Guardian earlier this year.

The review supported many of the complaints made by families — that children in crisis were not getting specialist help and were repeatedly passed between different services.

It said the two providers involved — Midlands Psychology, a social enterprise, and South Staffordshire and Shropshire Healthcare Foundation Trust (now named Midlands Partnership FT) — argued over which was responsible for the children.

The former was contracted for autism assessments, but there was a lack of clarity around which organisation was responsible for post-diagnosis support. This issue had also been raised by regulator Monitor in 2015.

Several recommendations from Monitor, following a review, included: the need to clarify contractual arrangements; improve the “difficult” relationship between the providers; improve referral and diagnosis processes; and run regular audits of services. 

”Not fit for purpose”

The service was first commissioned in 2010, to address long waiting times for autism assessment. But following repeated complaints from families, lead commissioner South East Staffordshire and Seisdon Peninsula CCG agreed to review the service and the providers in 2016.

A letter to one family from former accountable officer Andrew Donald, in August 2016, admitted the services were “not adequate and not fit for purpose”.

A “desktop” review was carried out, but the findings were not documented as it was not considered a formal review, the family was told.

According to formal governing body minutes, the CCG then continued to be alerted to safety concerns in early 2017.

”Limited value”

In November 2017, Marcus Warnes was appointed as single accountable officer for all Staffordshire CCGs, along with several other joint directors. In early 2018, SESSP commissioned Northumberland, Tyne and Wear FT to carry out the independent review.

In a letter to a parent earlier this year, Mr Warnes said there had been “minimal” visits to the service providers by commissioners since the service was launched.

He said this was because of the low value and activity levels associated with the contract, adding there were “no themes or trends” identified through feedback routes to the CCG. He also said Midlands Psychology had been rated “good” by the Care Quality Commission.

HSJ asked the CCG whether increased monitoring took place after the 2016 review, but the commissioner said it could not answer this question, as the governing body members involved had left.

Mr Donald, who was accountable officer from mid-2015 to April 2017, did not wish to comment.

New contract

Following the external review, commissioners decided to re-tender the contract for the autism service. They decided the NHS provider, which has been renamed Midlands Partnership FT, should take it over on an interim basis from this month.

The new contract, which will start in January and be worth £4.5m over three years, includes both assessment and post-diagnosis support.

In a statement, South East Staffordshire and Seisdon Peninsula CCG said: “At no stage has this contract been neglected. Patient safety is paramount and the CCGs would never knowingly leave a child at risk. The relative value of the contract in no ways lessens the importance of patient care.”

‘Failed miserably’

Earlier this year, Healthwatch Staffordshire produced a report which covered families’ concerns dating back to 2013. One family reported being told by both providers to ignore their child when they said they were going to kill themselves.

The mother of another young service user told HSJ her son had “ping-ponged” between the NHS trust and Midlands Psychology since 2014, and, despite expressing intentions to kill himself, was not offered the support he needed. She has since paid for private treatment.

Another said: “Since 2015, my son has suffered many bouts of anxiety; he has self-harmed and has talked about not wanting to be here anymore… I have tried to access support from CAMHS and Midlands Psychology and have been passed around the system as no one wants to take responsibility.”

Another mother said her 12-year-old boy had his referral for an autism diagnosis rejected at least 12 times between 2014 and 2017. She said the services “had failed him miserably” and despite attempting to and expressing the intention to kill himself at least five times since 2014, he did not receive the support he needed.

The women all said they had raised their concerns with both the providers and commissioners over the years.

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