A health minister has accused NHS organisations of “shunting” mentally ill children into specialist inpatient care for financial reasons.
Care minister Norman Lamb indicated the problem was due to the division of commissioning responsibilities under the 2012 Health Act.
The minister made the comments in an interview with HSJ following the publication last week of a report by NHS England into the future of inpatient and specialist child and adolescent mental health services. The report, which commits NHS England to investing in up to 50 more beds and carrying out a further review, follows widespread concern about the way the services have been commissioned.
Difficulties over the past year have seen children being admitted to adult wards, waiting for long periods in acute hospitals, and sent to beds hundreds of miles from their homes.
NHS England has been responsible for specialised CAMHS, known as tier 4 services, since April 2013 under the government’s commissioning reorganisation. Other CAMHS are commissioned by clinical commissioning groups.
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Mr Lamb suggested the division of responsibility was creating a perverse incentive for children to be referred to specialist inpatient services, so their care is funded by NHS England.
He said: “I believe there is a perverse incentive to shunt children into tier four services because [it means] NHS England takes over the financial responsibility. That’s about the design of commissioning.
“The shunting of children around the country is intolerable and we need to confront the failures that exist and address them. We have to question this fragmented commissioning between local authorities, CCGs and NHS England.”
He also revealed he wanted to create “pioneers in child mental health services”, which would “reinvent the way we [provide services], with very strong relationships between the voluntary and statutory sectors and which have unified commissioning”.
NHS England’s report on tier four CAMHS found evidence of children being inappropriately admitted to specialised units due to gaps in CCG-commissioned services. It said additional beds would be commissioned, 10 to 20 new case managers appointed, and consistent admission and discharge criteria set out.