Agenda item

(indicative timing: 10.45-11.15am)

In attendance for this item:

Sally-Anne Osborne - Associate Director for Children, Young People and Families and Specialist Primary Care, HWHCT.

Susanne Friess - Consultant in Paediatric Neurodisability, HWHCT.

Jenny Dalloway – Lead for Mental Health, Learning Disabilities and Children, HWCCG.

Sarah Wilkins – Director of Education, Early Years and Children with Disabilities, WCF

Tina Partridge – Group Manager, SEND Support Services, WCF.

The Panel received a report which provided an update on the Umbrella assessment and diagnostic pathway for children and young people who were or might be on the autistic spectrum. The Panel was reminded that the pathway provided a multidisciplinary assessment which included agreed referral criteria, triage, and multi-professional planning. Following this a diagnostic discussion took place and the decision made was detailed in a final report which was shared with the CYP and family.

The Panel was informed that the Service aspired to have a maximum waiting time of 6 months, and there had been significant challenges with meeting this timeframe over recent years.  Following a review in February 2021, a commissioner led task and finish group had been set up to support the services contributing to the Umbrella Pathway to establish ways to have a sustainable improvement. The CCG had then provided additional funding to help bring in extra capacity to assess and diagnose the CYP who had been referred prior to 1 April 2021 and were still awaiting diagnosis. The Associate Director was pleased to be able to report that as a result of this the backlog of cases had now largely been cleared, with only 21 children now remaining on the waiting list from within the identified cohorts of CYP.

The Consultant explained that it was acknowledged that as changes to the pathway were required, the overarching emphasis was that autism had to be everyone’s business with professionals needing to work closely together. To work towards change, in conjunction with partners, a systematic review of every step of the assessment process had been carried out to establish what streamlining could take place and what improvements could be implemented. In terms of referrals, it was important to gather vital information from all those who know the child best so that the relevant information was presented in a timely way to those who carried out the assessment process. Two specialists would then carry out the assessment using standardised tools to establish whether a diagnosis could be made. The Consultant explained that as the quality of the assessments had been improved, and with surety of diagnoses there has been less need for further assessments to be arranged, hence speeding up the process. There were plans for the future to invite other professionals to carry out checks on a child’s mental health history working to the same thresholds, which should work well. Long term plans were to develop a one-stop assessment service. 

Members asked a range of questions which were responded to as follows:

·         The Associate Director advised that waiting times were currently averaging 8 months, although there was a continual improvement towards the 6 months aspirational target. The Consultant added that, the time from referral to diagnosis was 8 months, but from the point of triage to acceptance following a referral, was currently 3 weeks.

·         The Lead for Mental Health commented that the autism pathway in Worcestershire compared very well to others across the country. The Team were praised for listening to the feedback received and the early response had proved to be very helpful. The Consultant added that feedback from parents had been positive about the quality of the service currently being provided.

·         The Chairman praised the recent performance in reducing waiting times and queried what would happen when the CCG funds were no longer available. The Lead for Mental Health advised that the additional investment was specifically agreed with the service as the amount required to complete the outstanding assessments of those CYP whose referrals had been delayed by the pandemic.

·         In respect of the wait between a referral and diagnosis for autism in CYP, the Panel was keen that it be ensured that the current service and the improving trajectory were maintained. 

·         A Member asked whether the numbers being diagnosed with autism had been impacted by the pandemic. The Consultant reported that diagnoses figures had been below national average levels. It was agreed that the Panel would be supplied with specific figures on the numbers of CYP being diagnosed.

·         A Member raised a concern about whether there was under-diagnosis of autism due to unmet need ‘ The Director of Education advised that education worked in partnership with health colleagues to identify those children with signs of autism at an early stage. Autism awareness was also promoted in schools.

·         A Member queried whether it was more difficult to diagnose girls who had autism as the signs were more difficult to spot. The Consultant explained referrals from schools were generally of a good quality, but she accepted that girls could be difficult to diagnose. Work was ongoing to upskill Paediatric staff to help with diagnosis and if a second opinion was needed, a referral would be made to Great Ormond Street Hospital.

Following a question about the process for referral to the Attention Deficit Hyperactivity Disorder (ADHD) pathway, it was agreed that it would be added to the Panel’s work programme.