On behalf of one of her constituents, Sharon secured an end of day Adjournment debate on Child and Adolescent Mental Health Services in the North East. During her speech, Sharon raised the case of her constituent and the difficulties they have faced when accessing CAMHS.
You can read Sharon's speech below:
Mrs Sharon Hodgson MP (Washington and Sunderland West) (Lab):
As hon. Members know, it is very difficult to secure an Adjournment debate—the last one took me over a year to obtain—so I was very pleased when this one was granted, especially as it is on such an important matter, as I will outline in some detail tonight. It is especially welcome that business has fallen early tonight, so I do not need to rush or curtail my remarks to leave time for the Minister. This is such an important matter and I know we will both have plenty of time to deal with this issue.
I would first like to thank my constituents for bringing their case to me, and for waiving their anonymity in the hope that their story can help other families and ensure that something like this does not happen again, as it could so easily have had a tragic ending. Going public like this is a very brave thing to do and I sincerely hope that their story, and today’s debate, will spark a change.
In March this year my constituent, Mr Thomas, wrote to me about his daughter Jane, and the
“deplorable treatment when attempting to access CAMHs support”.
Jane, aged 16 at the time—she is now 17—tragically lost her mother as a result of alcohol abuse. Everyone will appreciate the grief that this will have caused Jane and her family, and the lasting impact of that grief after years of watching a parent decline due to alcohol abuse. Many hon Members, such as my hon. Friend the Member for Leicester South (Jonathan Ashworth), my right hon. Friend the Member for Don Valley (Caroline Flint) and my hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne), have spoken about their own experience of growing up with similar experiences. I pay tribute to them, and to Jane, today.
Having experienced such loss on top of what she would have seen her mum go through over the years, Jane was understandably struggling with her mental health. Mr Thomas therefore felt that Jane needed professional intervention. Having consulted Jane’s GP, Jane was referred to North Durham child and adolescent mental health services at Tees, Esk and Wear Valleys Foundation NHS Trust. This is where Mr Thomas’s frustration begins.
Jane waited weeks for a CAMHS appointment following the referral, but it was not forthcoming. Mr Thomas went back and forth with the GP to ensure that the referral had been made, and was assured that it had. He was even shown the email confirming that. He then contacted the CAMHS team directly over the phone. As you can imagine, he was surprised to hear that they had no record of any referral regarding Jane. Mr Thomas says that this
“set the pattern of misinformation and incompetence that Jane and I were to encounter.”
Mr Thomas contacted CAMHS again to enquire whether an appointment would be made for Jane, and was told that Jane would not be seen as her need had already been assessed and her case was closed. That exasperated him further, as it referred to an earlier episode and a case from several years earlier, not the most recent case following the death of Jane’s mother. Therefore, it did nothing to inspire confidence.
Jane finally saw a CAMHS practitioner at the end of last year and was making positive progress, but her last appointment was on 4 January 2019. It is now July, and Jane has not had another appointment on the national health service in the past seven months. The initial reason for the delay was that Jane’s counsellor had left to start her maternity leave—something that, of course, she is absolutely entitled to do—but the trust will have been well aware for some time that the counsellor’s maternity leave would need to be covered. There also should have been a period of handover so that the service could continue its work smoothly. That did not happen.
Maternity cover was found after a gap of more than two months. However, just days after starting, that person resigned their position, leaving the trust unexpectedly without any cover. I am told that that was for personal reasons. It was at that point that the trust wrote to Jane Thomas, on 8 March, apologising for the delay in her treatment and suggesting that, if she had any inquiries, she should contact the team at North End House or, if she was in crisis, she could call the CAMHS crisis team. It was then three months since her last treatment.
It was upon receiving that letter that Mr Thomas contacted me to bring all this to my attention. There was nothing in the letter to Jane—I have seen a copy of it—to suggest that she should contact the trust to arrange an appointment or alternative provision; it just said to call if she was in crisis. I therefore wrote to the trust on 18 March, asking them to examine this matter further and advise Jane and Mr Thomas.
On 29 March, I received a reply that said that the trust had
“looked at interim solutions, such as part time staff working additional hours.”
It did not say whether that was actually happening, or whether that would include an offer of support to Jane, only that they were looking at it. That was just one of the many opportunities that the trust had to take another look at Jane’s case, to see what interim solutions were in place for her and to make contact with her directly, perhaps by calling her, as they did yesterday—I will come to that in a moment. But that did not happen.
Yesterday, I spoke to Mr Levi Buckley, director of operations at the trust, in advance of this debate. We had been trying to arrange a call for some time and could not get the dates to match, but obviously that changed once I secured this debate. I was told yesterday that alternative arrangements had been put in place for the majority of patients. He told me that when Jane’s counsellor went on maternity leave in January, all those patients should have had their cases reviewed and reassigned to another counsellor or another support network. However, for whatever reason, that did not happen for Jane, although I am told that it did for all the others. Jane had obviously, and shamefully, just slipped through the net. The trust realised that, no doubt prompted by Mr Thomas, and in March, when the new counsellor started and then left after two days, they contacted Jane to apologise with the letter dated 8 March that I mentioned earlier.
There was no concerted effort at any point by the trust to re-establish contact with Jane, who for all they knew was getting no support at all with her mental health. There was just that one letter. Even after I contacted the trust on 18 March to begin this dialogue, they still made no further contact with Jane until yesterday, when she was called within two hours of my conversation with Mr Buckley, prior to this debate. I understand that Jane spoke to the head of the CAMHS service, who apologised and offered her transitional provision to move her into adult services, as she is 18 later this month. It is, of course, entirely up to Jane what she decides to do.
Having spoken to the trust, they agree that they could have done more to make contact with Jane, who obviously was easily contactable, as they spoke to her without delay yesterday. There have been many opportunities available, since March when I first contacted the trust on behalf of Mr Thomas and Jane, to make that direct contact and arrange counselling provision for Jane, but that did not happen. That means that a vulnerable young person had fallen through the gaps because of incompetence, and even when it had been brought to their attention in March, nothing was done to rectify the situation until yesterday.
It does not need me to point out that this could have been fatal, had Mr Thomas not sought and paid privately for mental health provision for Jane. I understand from my call with Mr Buckley yesterday that the situation at the trust was made more difficult because, after advertising the job twice and getting no applicants, they had had to lower the grade of the position—meaning that the person would require more supervision—in order to attract someone they could employ. This person is due to start in September—nine months after the counsellor on maternity leave left. Mr Thomas emailed me earlier today to say that the
“analogy of too many Generals and no Soldiers would suggest itself”.
In April, when I met Mr Thomas in my constituency surgery, he was very clear that this was about incompetence and bad management within the trust that had allowed his daughter to slip through the cracks. What has most frustrated him about this ordeal is the lack of accountability for what he calls the
“appalling management of the service”.
He went on:
“This CAMHS organisation is poorly led, poorly administered and managed with incompetence.”
Can the Minister please inform the House who should be accountable for these failures?
A freedom of information request made in 2018 to the Care Quality Commission by a concerned parent inquiring into numbers of complaints made against CAMHS went unanswered, with the CQC stating that it did not have full oversight of this organisation and therefore could not provide the requested information. Who does oversee CAMHS? Who should be taking responsibility for the vacancy gap and the real problems that the trust has had in filling the vacancy, and for the impact it has had on vulnerable young people who need access to support? What advice can she give to my constituent, who just wants to help his daughter get the professional treatment she needs, when she needs it, on the NHS? Does the Minister think that trusts should not be able to mark their own homework on such cases? They must surely be held accountable when there are failures and recognise the need for change. I hope that this debate brings about some change.
Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab):
I thank my hon. Friend for bringing this debate to the Chamber, and for explaining the importance of mental health services in the north-east. In Scotland in the last five years, there has been a 50% increase in the number of suicides among 15 to 24-year-olds. We need to do something about this national crisis.
I thank my hon. Friend for his intervention. I would encourage him to apply for a debate with the same title, only with “Scotland” at the end instead of “North-East” so that he can explore that 50% increase in greater detail. If he is lucky, he might get a nice long session like me, but I know the Minister will have heard his comments.
Throughout all this incompetence it is Jane who has suffered. If this is an issue of recruitment and retention, which it seems to be, what will the Minister do to ensure that CAMHS staff are both recruited and retained nationally, and specifically in the north-east? Nationally, the number of consultant child and adolescent psychiatrists fell by 4.5% between October 2013 and October 2018, which might account for why it was so hard for the trust to recruit someone, while the Government are on track to miss their mental health workforce target by 15,000 staff. Labour research in January found that the total number of mental health nurses had fallen in every month the previous year. I should be grateful if, in her remarks, the Minister would address the issues that led to this decline in the number of mental health nurses and evaluate the impact that it is having on young people such as Jane.
If an A&E just closed its doors because of a lack of staff and stopped treating people, there would be an outcry—we would not stand for it—so why do we allow it to happen when it comes to mental health? The Prime Minister said she wanted mental health to be a priority, but the Government are nowhere near achieving that goal. Mental health awareness is one thing, but it must be matched by mental health support and treatment services, and that is where the Government are failing, especially with regard to staffing.
According to research carried out by the Children’s Society, more than 110,000 children a year are unable to access mental health support from a CAMHS service, despite being referred for support. Three out of four children with a diagnosable mental health condition do not receive the support that they need, according to similar research conducted by YoungMinds. This is therefore not a problem exclusive to the north-east—or even Scotland, as we have just heard from my hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney)—which is why the Government must take action.
I wrote to Tees, Esk and Wear Valleys NHS Foundation Trust, which informed me that it did not operate a waiting list in County Durham and Darlington CAMHS. However, Jane and other young people, across the north-east and the whole country, are still waiting. It beggars belief that the trust could say that, but it is in the letter that it sent to me.
As I have said, Mr Thomas was left with no choice but to engage a private practitioner. That came at a huge cost to him and his family, but as a loving parent he felt that he had no other option. No parent should be put in that position, and not all parents have the means to step in when the services let them down so badly, as was the case for Jane.
According to the Royal College of Psychiatrists, mental health trusts have less money to spend on patient care in real terms than they had in 2012. Of course, lack of funding means that trusts are strained and unable to provide vital services. Is that what led to the staffing problems in this trust? Was its inability to fill the vacancies down to the salaries being offered, or was the workload that was being demanded of staff too high? Why did that new person leave after only two days? Will the Minister support Labour’s calls for the ring-fencing of NHS mental health budgets and an increase in the proportion of those budgets that is spent on support for children and young people? Increased funding will relax some of the pressure on services, and will ensure that they can be sufficiently staffed and resourced to improve patient experiences.
As I said at the beginning of my speech, Mr Thomas and Jane were very brave to allow me to share their story with the House in so much detail today. However, it should not have come to this. Jane, having mental health problems, should have been referred to CAMHS, been assessed and then been given therapy appointments as necessary to support her recovery—unbroken, with no seven-month gaps in provision. Instead, she and Mr Thomas have been back and forth and have had to fight, and even pay, for the support that she needs and to which she is entitled.
Mr Buckley, from the trust, informed me that North Durham CAMHS had seen an 18% rise in referrals over the last year. It follows that as the number of referrals rises, the funding must also increase to meet that need. The Government must increase the proportion of mental health budgets spent on support for children and young people: they must make mental health a priority, with actions and not just warm words.
While the staffing crisis and mismanagement at Tees, Esk and Wear Valleys NHS Foundation Trust rages on, Jane still has no access to treatment and support on the NHS, although I have been told that she received a call yesterday suggesting that the problem might be resolved shortly. I therefore ask the Minister what she will do for Jane, and young people like her, to ensure that situations like this do not occur in future.