Sheffield children's mental health: Report raises concerns over treatment waiting times and emergency support

The issues were among those raised in the latest Care Quality Commission into children’s mental health services run by the Sheffield Children’s NHS Foundation Trust, sparking concerns from city MP Louise Haigh.

The CQC carried out an inspection of child and adolescent mental health wards (CAMHS) and specialist community mental health services for children and young people in July, partly due to receiving concerns about the quality of care being provided in the CAMHS inpatient wards.

Following the inspection, the ratings for the CAMHS inpatient wards remain the same – good overall and for being effective, caring, responsive to people’s needs and well-led.

The specialist community mental health services for children and young people remains rated as ‘requires improvement’ overall, and for being safe and responsive. The ratings for being effective, caring and well-led improved from requires improvement to good.

Teams are based at sites including Beighton, Centenary House, Albion House, Gibson House, Star House, Amber Lodge and the Acute Hospital site.

What concerns were raised?

But concerns were raised that in specialist community mental health services for children and young people, youngsters waited a long time to access the service, clinicians had high caseloads which had an impact on their ability to provide safe care. And parents told inspectors they were concerned about the lack of urgent out of hours provision where their option was limited to attending the accident and emergency department.

Sarah Dronsfield, CQC head of hospital inspections, said: “During our inspection of mental health services for children and young people at Sheffield Children’s NHS Foundation Trust, we found leaders had a good understanding of the service they were running and were visible and approachable.

“In the child and adolescent mental health wards (CAMHS) staff felt proud to work in the service and told us they were part of a supportive team, who cared for people, as well as each other. It was good to see staff were supported to improve their knowledge and skills and were encouraged to progress their careers.

“However, in CAMHS inpatient wards we did find issues around environmental risks and blanket restrictions. Doors were locked to most communal areas on Emerald and Sapphire Lodges, including the female lounge and quiet rooms. Although staff were happy to unlock the doors when people wanted to go in, they couldn’t freely access these rooms, which they should be able to do to give them more independence.

“In the specialist community mental health services for children and young people, waiting times and caseloads for practitioners remained high. Also, appointments that were cancelled by the service weren’t always re-arranged in a timely way which could put people at risk.

“The trust has started to take action to make the necessary improvements and we will return to check on progress.”

What improvements have been made?

Yvonne Millard, chief nurse at Sheffield Children’s NHS Foundation Trust, said: “Since our last inspection, our teams have worked incredibly hard to provide good quality services and make improvements, whilst also responding to the challenges of the pandemic and a rapid increase in the number of young people needing our care and support. We are delighted that the CQC have seen significant improvement in our Community CAMHS service in spite of these challenges.

“We recognise there is more we can do and we have already taken action on many of the points raised by inspectors. By listening and learning from others – and most importantly the young people and families we support – we can continue our journey to providing outstanding care.”

Areas raised for improvement included: increasing the availability of communal spaces like quiet rooms – while young people were able to ask to go in, they couldn’t always access them independently; some delays in rearranging cancelled appointments; system access for agency colleagues; waits for services; the number of children assigned to each clinician.

Areas highlighted as positive included: Good feedback from patients and their carers; children and young people said they felt safe and well cared for; parents and carers said they felt involved and kept up-to-date; Recognition that staffing levels were managed well in the context of a national staffing crisis

How long are waiting lists?

The report stated the service did not meet trust target times for seeing patients from referral to assessment and assessment to treatment. Data provided by the trust showed that a total of 1,027 people were waiting for their first appointment. Of these 911 were waiting for their first appointment with the community mental health team; 684 people were waiting longer than the recommended 18 weeks for a first appointment, and 94 people were waiting more than 52 weeks for their first appointment with the community child and adolescent mental health team, which the service considered to be a breach.

Louise Haigh, MP for Sheffield Heeley, raised concerns over the findings on access to the service.

She said: “The latest CQC report will be of little surprise to children and young people and their parents who are struggling to access mental health services across the city and are having to sit on ever-lengthening waiting lists.

“The staff that work in mental health services are rightly proud of the treatment they provide, and it is welcome that the CQC acknowledged this, but waiting times are too long and practitioners' caseloads are far too high. This is potentially prohibiting them from providing safe treatment.

“We desperately need investment in our mental health services so that dedicated staff can support children and young people before they get into crisis, and we need emergency provision so that people don't have to rely on A&E.”