Revealed: Ten-fold increase in children waiting too long for specialist care

There has been major concern about worsening mental health of children and young people through the pandemic, but these are thought to be the first official figures to emerge indicating the extent of the growth in waiting times.

Board papers show that, across the NHS’ South East region, from mid-March to mid-April this year, about 50 young people each week were waiting more than the recommended time for admission or transfer into a child and adolescent inpatient mental health unit. Last June, the weekly average was less than six.

The papers show much of the rise was due to eating disorders referrals, which rose from five in June to nearly 30 in early March. However, other specialist services also saw rises.

Children who are waiting for these specialist places — known as “tier 4 beds” — may already be inpatients in an acute hospital, or could be at home/in the community.

The target time for admission to a specialist bed depends on the circumstances: Emergency admission should occur within 24 hours, urgent transfers should be “responded to” within 48 hours, and routine referrals within a week, according to NHS England guidance.

A report to this week’s meeting of Kent and Medway Clinical Commissioning Group warned that demand for tier 4 beds had been on an “unsustainable trend” since June 2020.

Overall CAMHS demand is growing — referrals increased by up to 107 per cent in 2020-21 according to the board papers — and they are expected to increase again between 40 and 60 per cent in this financial year.

But the impact on tier 4 beds appears to have been compounded by “an increase in the complexity and acuity of children and young people entering services” in specialist services.

The report noted a statistically significant increase in children and young people with eating disorders seen by specialist mental health services over the period — up to 211 in March this year, compared to a pre-covid average of 154 a month. There has also been an increase in young people self-harming, it said.

It said the CCG is working with its CAMHS provider — North East London Foundation Trust — to introduce an intensive home treatment model which it hopes will reduce its reliance on tier 4 beds. It is also investing in improved eating disorders treatment, and more mental health workers in acute hospitals, and it has set up a “crisis vigilance dashboard” to monitor pressures and capacity.

The South East has lost a number of private provider CAMHS beds recently. HSJ reported last week that a unit at Ticehurst House in Sussex, run by the Priory Group, has closed. This had 25 beds, although only eight were occupied when the decision to close was taken. Last October, the CAMHS unit at Cygnet’s Godden Green Hospital, near Sevenoaks, also closed.

Commissioning the services is legally NHS England’s responsibility, although it has “devolved” this to provider collaboratives across most of the region. An NHSE spokeswoman said: “As part of the long term plan, the NHS is investing significantly in community mental health services for children and young people alongside local investment in CAMHS Tier 4 services.

“The NHS in the south east is working closely with the Kent and Sussex Provider Collaborative and community mental health providers to scale up alternative services following the unplanned closures of Godden Green and Priory Ticehurst.”

Meanwhile, NHS Providers — which released a major report on mental health services this morning — told HSJ that trust leaders surveyed had reported a 49 per cent increase in demand for young people’s eating disorder services over the last three months to a year, together with an increase in complexity and acuity of those trying to access CAMHS.

More than five out of six of those who responded said they could not meet demands for eating disorder services, and two-thirds could not meet demand for community and inpatient CAMHS.