Agenda item

Attending for this item were:

Kath Cobain, Director of Public Health, WCC

Stephanie Courts, Worcestershire Health and Care NHS Trust

Jenny Dalloway, Worcestershire NHS Clinical Commissioning Groups

Sue Harris, Worcestershire Health and Care NHS Trust

Sally-Anne Osbourne, Worcestershire Health and Care NHS Trust

Colleagues had been invited to provide an update on the assessment and diagnostic pathway for children and young people who it was considered were, or may be, on the autistic spectrum.  This pathway was known in Worcestershire as the Umbrella Pathway.

The responsibilities of partners were confirmed.  The Worcestershire NHS Health and Care Trust (WHCT) was the provider of the service, Worcestershire County Council (WCC) was the commissioner, and funding was provided by the Clinical Commissioning Groups (CCGs).

It was confirmed that the expectation was that support would be provided to families once children were on the pathway.

Members were provided with a presentation and the following main points were made:

·       The performance of the service had previously been considered by the Overview and Scrutiny Performance Board in May 2019.  At that time, the Board had considered that not enough progress had been made and had requested that the Business Case should be considered by the Children and Families O&S Panel as soon as it was available.

·       Since then, the service had been working closely with the Local Authority in relation to the SEND graduated response, which clearly laid out the expectations of all partners and the need to work together.

·       This need for partnership working was also a key feature of the NHS Long Term Plan which aimed to stabilise systemic changes.

·       The backlog of cases was due to the number of pupils being referred onto the pathway.  One aim was to identify those children whose needs were less complex and ‘fast track’ them through the system.  This would not be possible for all cases and would depend on the complexities of the child and their family situation.

·       The aim was to reduce the backlog by increasing the number of diagnostic meetings.

·       Longer term support for children with exceptional needs, including 1-to-1 work, would need to be done in partnership with education colleagues.  An example of exceptional need would be a child or young person who was unable to attend school because of anxiety.

·       Anxiety workshops had been held recently, delivered by a facilitator with lived experience and these had received positive feedback.  Those attending could also be signposted to other support.

·       The referral process had been reviewed and now included parental and school questionnaires at the referral stage, additional information which would help at the planning meeting.

·       Although it was acknowledged that all cases were complex, those judged to be more straightforward could be fast tracked.  The aim was to hold a clinic with two professionals to identify those cases to be fast tracked.

·       Diagnostic meetings were multi-disciplinary.  These were not attended by parents and may involve discussion of more than one child.  The resulting reports were usually shared within two weeks.

·       The aim was to implement enhanced referrals in October 2019.  Good communications would be key to ensure that referrers understood the additional information that was needed.  There was also a need to recruit additional staff.  It was important that the clinic had the right professionals in the right setting.

·       It was envisaged that from April 2020 no one would spend more than 6 months on the pathway, with exception reporting in place if a case went over this.

·       It was confirmed that there were two levels of investment.  Firstly, there was investment to clear the backlog of cases.  By April 2020 the waiting time from referral to the start of the pathway would be no more than 15 weeks.  Secondly, there would be ongoing sustainable investment once the backlog was cleared to continue to find opportunities to reduce waiting times, something that was not a simple process.

·       The autism section of the NHS long term plan referred to the need for waiting times to be improved.  The aim was to be meeting best practice by 2021/22.

Members were given an opportunity to ask questions and the following main points were raised:

·       In response to a question from the Chairman, it was confirmed that support for children with ADHD (Attention Deficit Hyperactivity Disorder) was provided via referral to the Community Paediatric Department where diagnosis would be made and ongoing support provided including medication if necessary.

• The number of referrals received by calendar year 2016-2018 increased significantly in 2017, reduced in 2018 and increased in 2019.  An explanation as to the reasons why was requested.  It was suggested that this may be because, although the number of referrals coming in was still high, the number assessed as needing support had gone down.  Other cases were referred back to the educational setting.  Children would not be accepted onto the pathway if it was not in their best interest to be diagnosed with autism.
• It was noted that there had been a significant rise in referrals since 2016 and the reasons for this were queried.  It was suggested that in 2017 in particular, there had been a rise in awareness of autism.  At the same time, there had been changes in how support was accessed via the education system.
• A question was asked about how the SEND graduated response was being publicised with schools as one Member who was a school governor was not aware of the development.  It was confirmed that the Local Authority was currently looking at how best to communicate with schools.  It was agreed that school governors should be included in any communications to schools about the SEND graduated response.  It was confirmed that the launch with schools would be in October.
• In response to a question about recruitment plans, it was confirmed that some additional staff had already been recruited.  However, it was acknowledged that there were challenges with recruitment as all organisations were trying to recruit from the same pool of qualified staff.  Members were informed about a new recruitment campaign which included the tagline ‘Together We Can’ which would highlight the overall package offered.  The Trust had been as creative as possible looking to upskill existing staff.  For example, an Advanced Clinical Practitioner post had been created which, although not a replacement for a Doctor, could take on much of the same work.
• Concern was expressed about the length of waiting times to date as 12 months was a very long time in a child’s life.
• It was suggested that some parents may need support to provide initial information for the referral and assessment process.  It was confirmed that all families were asked about whether they had additional needs and support would be provided if necessary.  Often, parents would work with schools to provide the necessary information.
• With reference to ‘dual assessment’, it was suggested that two assessments in one day may be stressful for children on the autistic spectrum.  It was confirmed that this would involve one professional working with the child and another with the parents.  The child would experience one assessment by one or two professionals.  This may be in an environment familiar to the child, but this could not be guaranteed.  Some Speech and Language assessments had been held on Saturday mornings and this had received positive feedback from parents.

• It was agreed that the Key Performance Indicators (KPIs) for the Assessment Pathway would be shared with the Panel.

• It was confirmed that the proposal would require some staff to move from the Speech and Language Team to the Umbrella Pathway Team.  This would involve a request for expressions of interest.  If there were no volunteers, there would be a need for management of change.  However, Members were reminded that staff were committed to the service and it was not anticipated that this would be an issue.
• It was confirmed that even without any volunteers to move teams there would be no delay to the process as it would be possible to deliver assessments from the current structure.
• Members welcomed the idea of a one stop shop for the less complex cases.
• Concern was expressed about the reference in the report to gaps between services.  Members were informed that this related to decisions about which was the right service for the child to access.  Work was ongoing on a system of triage to ensure referral was to the right service.
• Although Looked After Children were not currently able to access a fast track through the system, it was agreed that this would be considered in the future.  This was welcomed as it was suggested that the emotional stress of being taken into care could exacerbate a child’s autism.
• It was confirmed that the Business Case had now been approved by CCG commissioners.
• The employment of a Post Diagnosis Facilitator was welcomed as something that would make a difference to families.

In conclusion, the Chairman congratulated colleagues on the improvement in the service and the plans for the future outlined in the Business Case.  The Panel requested a further update in the second half of 2020 once the new service model had been implemented.