The must-read stories and debate in health policy and leadership.

Last month HSJ reported on warnings from commissioners and trusts over an emerging crisis in the availability of child and adolescent inpatient mental health beds.

This week the crisis appears to have come to a head after senior clinicians told HSJ there were no beds available to admit seriously ill children last week.

The key problem appears to be with increasing numbers of children needing treatment for eating disorders, for which specialist beds are far and few inbetween.

NHS England has disputed there were not CAMHS beds available. However, clinicians have since countered to HSJ that units can refuse patients if they are too high risk, and this is particularly common for children with severe eating disorders.

The surge appears to be a wider symptom of a lack of provision within the community also. Experts at the Royal College of Psychiatrists have pointed out commissioning guidance, NICE guidance and recommendations from the PHSO for the improvement of eating disorder services. However, none has come with the necessary funding.

So, what happens to the children for whom there are no beds? Sadly, they’re kept on acute paediatric wards, which are not properly resourced to treat or support their recovery.

Headlines covering a crisis in mental health services have become common in years past. But the latest surge appears unprecedented – is it the straw that has finally broken the camel’s back?

Another rollover…

HSJ revealed yesterday that system leaders now expect the financial arrangements for NHS providers, introduced to help the service deal with the pandemic, to be rolled over yet again until the autumn.

The payment by results system was suspended in April 2020 for an initial four month period. Block contracts were subsequently rolled on for the rest of the 2020-21 financial year – and are now likely to remain in place for the first six months of 2020-21.

Although uncertainty is rarely welcomed by local leaders, the continuation of the block contracts suggests calls for the workforce to be given a break in early 2021-22 have been heard, and local systems could be given a brief hiatus before being handed ambitious restoration targets later in the year. And this would be most welcome indeed.

The national planning guidance is expected to set out more details on Thursday.