How we designed and launched a brand new service which keeps vulnerable children and young people out of hospital while they are treated for mental health issues in Devon
Virgin Care designed and developed the Assertive Outreach service to support children, young people and families through mental health issues and helps keep some of the most vulnerable children and young people out of hospital and at home with their families and friends by providing additional support to stay safe while they receive treatment from our Devon Child and Adolescent Mental Health Service (CAMHS).
The brand new service made a big difference, by reducing the average number of children and young people from Devon in mental health units down to 10 and is supporting more than 30 children and young people at one time while they receive care at home, saving the NHS up to £5 million a year.
CAMHS across the country has seen a steep increase in demand, and when we began providing the service in Devon, as part of Integrated Children’s Services, we inherited a long waiting list and more than 1,000 families who were waiting more than 18 weeks to begin treatment.
CAMHS provides community and home-based interventions for children and young people facing depression, anxiety, self-harm and eating disorders and other mental health issues up to the age of 19. The service also works with children and young people from Devon who are in mental health units across England.
Research has shown that children and young people benefit from receiving treatment while they are at home, with their support network of family and friends around them – and so our clinical team set about designing a service which would reduce the costs to the NHS of providing treatment, allowing more people to be seen more quickly, and keep families together.
Complex cases and disruptive bed admissions
Devon, as a very rural and sparsely populated county, does not have a significant number of inpatient mental health units – and none which are specifically for eating disorders. This means that when an admission is required, often at very short notice, children, young people and families have to travel long distances to the nearest available bed.
In addition, the increase in demand driven by social media and increasing complex family situations across the country means that mental health unit bed occupancy is high at around 80% on average – and costs of providing the units, as cases get more complex, is rising.
It’s been estimated each 10 beds cost the NHS around £2.43 million in 2015-16. On average, children and young people from Devon were occupying around 30 beds at any one time.
With research showing outcomes for mental health issues in children and young people are improved by staying in a familiar place, with a support network of family and friends in place, traveling long distances to these units is less than ideal. Understandably, the situation was leading to complaints from families, increased costs both for the wider NHS and for the CAMHS service as it worked to support children in far-away units, and was causing disruption for families’ other children.
Clinical teams step up to challenge to reduce admissions to distant mental health units
Our clinical team stepped up to the challenge of reducing the number of children and young people with mental health issues who needed to be admitted to potentially distant mental health units.
Engaging closely with families and previous service users, and reviewing evidence from previous serious case reviews and incidents in Devon, the team were able to co-design a new service which would mean more children and young people with mental health issues would be able to be kept, safely, at home with their friends and family while continuing to receive the help they needed from the CAMHS service.
The service would reduce the number of children from Devon admitted to Tier 4 mental health bed units across the county and work with families and the CAMHS service to keep children safe, and at home while they recovered.
A review of the last few years’ inpatient data suggested that the team would need to support an average caseload of 30 of the most serious Tier 3 cases in Devon, and work with other children’s services to avoid admission to a mental health unit.
30 children and young people supported by Assertive Outreach Team at any one time
The service was developed at a time of fast-increasing demand, while the wider CAMHS service was focused on reducing waiting times and had increased its capacity by more than 2,000 appointments per year to tackle the backlog we’d inherited in 2013.
Having designed the service in full, developing service specification documents and operating procedures, the clinical team presented a business case for delivering the new service to commissioners NHS England and NHS North, East, West Devon Clinical Commissioning Group.
The service was given the green light by commissioners, and set ambitious targets for the results it needed to achieve. Virgin Care began recruiting the multi-disciplinary team it needed to launch the service, and began delivering it in 2015.
- The Assertive Outreach Service was also able to support the development of the Eating Disorder Pathway in partnership with our local NHS Trust. The pathway, which has been commended by NICE as one of five high-performing services in the country, involves the Assertive Outreach team working with families during recovery.
- You can read more about that work in our case study ‘How we created a new pathway and reduced the need for Tier 4 Eating Disorder referrals ’
Assertive Outreach success in supporting 30 of most vulnerable children
Virgin Care’s Assertive Outreach model for CAMHS has been a big success, supporting 30 children and young people to stay safe at home surrounded by their family, friends and belongings while they recover from mental health issues and receive treatment from our community CAMHS teams.
The service helps build and improve the support network around the patients, enabling parent(s)/carers to learn, develop and practice the skills they need to confidently look after children and young people with mental health difficulties, and to identify and support them should they relapse.
The service also focuses on minimising risk, helping keep the children and young person safe and advising parent(s)/carers on the steps they can take too.
Virgin Care’s team designed, developed and then delivered the Assertive Outreach team in partnership with NHS England and NHS NEW Devon CCG to reduce the number of children and young people who used mental health unit beds and it has delivered results on this too.
74% reduction in children and young people from Devon in bedded units across country
From an average of around 30 children and young people from Devon in units across the country before the team was launched, now there is an average of 8-10 children at any one time admitted into the units – a 74% reduction, potentially helping to save the NHS around £5 million a year.
Those who are admitted also stay in the units for less time, with the support from the Assertive Outreach team facilitating a safe, earlier discharge – and increasing the patient experience positively.
The Assertive Outreach team have also future-proofed the service, and have the ability to increase capacity beyond 30 children if demand were to increase in the future, subject to funding for additional places.
The service could also be commissioned elsewhere in England to similar effect, reducing spending further and helping to improve outcomes for hundreds of the most vulnerable children and young people who are currently being admitted into inpatient units.
95% % of children and young people referred to CAMHS now begin treatment within 18 week of being referred
The wider CAMHS service has also had wider success with tackling the long waiting times it inherited. In December 2016, 95% of children and young people referred to the service now begin treatment within 18 week of being referred; the median wait for a routine appointment is just 6.6 weeks compared to a national average of around 26 weeks, and urgent cases are often seen within 24 hours.
The Assertive Outreach Service will be fully reviewed during 2017-18 , and the clinical team will closely analyse the work they have done since 2015 to review how it has saved money for the NHS and improved the patient experience.
Later in the year, the team will work with previous service users to plan improvements and changes which will make the service even more effective.
¹NHS Benchmarking Network, Raising standards through sharing excellence, CAMHS Benchmarking report 2016, http://members.nhsbenchmarking.nhs.uk/private/docs/projects/2016/CAMHS-2016-Final-Report.pdf