Agenda item

Attending for this item were:

Herefordshire and Worcestershire Health and Care NHS Trust

Sue Harris, Executive Director of Strategy and Partnerships

Sally-Anne Osborne, Associate Director for Children, Young People & Families

Stephanie Courts, Lead Children’s Nurse and Clinical Services Manager

NHS Herefordshire and Worcestershire Clinical Commissioning Group

Maria Hardy, Lead for Children and Maternity

Worcestershire Children First

Gabrielle Stacey, Assistant Director for SEND and Vulnerable Learners

By way of introduction, the Associate Director for Children, Young People and Families reminded Members that they had previously discussed the assessment pathway for children and young people who may have autism in September 2019.  The Clinical Commissioning Group (CCG) had supported the Trust by providing funding for the pathway as it was recognised that there were significant delays from referral to diagnosis.  There had been significant progress but further challenges remained and the service was not yet where it wanted to be.

The Panel received a presentation from the Lead Children’s Nurse and Clinical Services Manager (HWHCT).  In the course of the presentation, the following main points were raised:

·       Delays in Autism Spectrum Disorder (ASD) assessment had been a national and local challenge for some years.  The Pathway had been re-designed in 2017 with an expected maximum of 40 referrals per month in mind.  However, the level of referrals had varied between 40 and 100 per month causing significant delays.

·       Investment from the CCG had been received in 2019.  At that time, it had been very challenging to recruit staff with the right skills.  However, it was confirmed that all posts had now been filled.

·       The referral process had improved significantly since January, giving teams the right information in order to decide whether to proceed to an assessment.  Members were reminded that teams were required to involve both parents in the process even if they were no longer together and this sometimes presented challenges and could be a cause of delay.

·       In March all assessments for children on the pathway were halted following a Government directive that all non-essential services should be stopped due to the COVID pandemic.  Medical staff were redeployed to an acute setting and other staff were also redeployed to assist in the COVID effort.

·       Virtual assessments, in particular for teenagers, had been trialled.  Initially there were challenges with this approach but improvements were made and some assessments were still carried out virtually.

·       Staff who remained in the team were able to hold virtual multi-disciplinary meetings which had focused on planning and diagnostic discussions.  With reference to diagnostic discussions, the waiting time following assessment had reduced from 6 months to 4 to 6 weeks.

·       At the start of lockdown, an email account had been set up for families who wished to seek support and this had been accessed by over 100 families.  Web based training in emotional regulation had received more than 19,000 hits.

·       The Panel received information on numbers of children currently waiting for individual assessments.  Although waiting times for Speech and Language Therapy, Clinical Psychology, Occupational Therapy and Community Paediatrics had risen since July 2019, those for diagnostic discussion has fallen significantly.  Waiting times from referral to planning were 4.5 weeks in September 2020 (well within the National Institute for Health and Care Excellence (NICE) guidelines of 15 weeks).

·       The overall waiting time from referral to diagnosis was not where it needed to be although significant improvements had been made.

Following the presentation, Members were given an opportunity to ask questions and the following main points were made:

·       The Chairman of the Panel recognised that, although there had been a significant improvement in waiting times, there was still a long way to go before the service was where it should be.

·       A Member wished to acknowledge the substantial progress made in the last year despite the challenges of COVID-19.  She went on to ask whether development of a child’s Education, Health and Care Plan (EHCP) would run alongside the assessment process.  In response, it was confirmed that for some children the two processes would run in parallel, although it was helpful if they were undertaken in the correct order.  Ideally the Umbrella Pathway would be concluded so any diagnosis could be included in the EHCP.  However, the development of an EHCP was not dependent on a diagnosis and support provided in school was determined by observed needs rather than any diagnosis.

·       In response to a question about what was being done locally to build up skills and attract talent, it was confirmed that the service had invested in staff skills.

·       It was confirmed that the 4.5 weeks referral to planning were included in the 60.73 weeks referral to diagnosis and not in addition.

·       Although international comparisons were not easily available, in terms of regional benchmarks, the service was about average.  No local authority was doing quality assessments in a timely manner.

·       The Panel was told that, in an ideal world, waiting times would be reduced by the end of the financial year.  However, in reality this was more likely to take 9 months but sooner if possible.  The aspiration would be to achieve an average waiting time of six months, recognising that some children would be assessed more quickly whereas for others the process may take longer.

·       It was confirmed that, initially, COVID had resulted in fewer referrals although a large increase had been seen as schools had returned from September.  There were fewer referrals when compared to last year and it was suggested that this was in part due to COVID but also a result of the new referral process which provided better information at the start in order to make the decision as to whether to go ahead with the assessment.  It was acknowledged that the reduction in the number of referrals received was one factor in the reduction in timescales amongst others.

·       Members were informed that a child’s needs would still be met while undergoing assessment and a diagnosis should not have an impact on meeting those needs.  Where possible access to services was not dependant on a diagnosis.  However, Members were told about the Complex Communication Needs Team (part of the education service) which offered a traded service and a free service.  Access to the free service was dependant on a diagnosis something which WCF was reviewing as it was felt to create a perverse incentive for families to seek a diagnosis.

The Chairman thanked colleagues for their contributions and for their honesty about the challenges faced by the service.  A discussion on how to move forward with the information received would be held later in the meeting.