Services under pressure

23rd March 2013

  • With the NHS having to save £20bn by 2015, and Sheffield City Council facing £50m of cuts in 2013/14 on top of cuts made in the last two years, our public services are feeling the pain. Whilst disabled children’s services in Sheffield appear to have got off comparatively lightly, several are groaning under vastly increased caseloads. We examine developments in three local services: Speech and Language Therapy, the Autism Service, and CAMHS (Child and Adolescent Mental Health Service).

    Across the UK, the number of school pupils with speech, language and communication needs has risen by around 70% in the past six years. This trend has been attributed to a number of factors – such as improved survival rates of very premature babies, the recent “baby boom”, earlier identification, and even increased television viewing.

    Whatever is causing this increase, we’re certainly not immune to it in Sheffield. Referrals to our local Speech and Language Therapy Service have shot up by 23% since 2010, putting huge pressure on an already under resourced team. The average caseload of a school therapist in Sheffield now stands at 450 children.

    Sheffield’s lead commissioner for children’s health services has been meeting with Parent Carer Forum representatives and is using their feedback to improve services. We are very pleased that paediatric speech and language therapy has now been identified as one NHS Sheffield’s commissioning priorities for the next financial year, with plans to sustain current funding and prioritise additional investment. But before we break open the champagne, here’s a sobering thought: it is likely that any additional funding will be swallowed up by the increase in new referrals, and is unlikely to improve the therapist-to-child ratio overall.

    The Autism Service, which supports pupils with autism and related disorders in mainstream schools, has also seen a sharp increase in new referrals – averaging 25 per month over the past year. Since 2010, the team’s overall caseload has increased by almost 250 pupils, reaching a total of 1,047 in January 2013. As with speech and language needs, the increasing prevalence of autism reflects a national trend.

    However, unlike the Speech and Language Therapy Service, the Autism Service is not expecting a funding increase. Staffing levels are likely to remain at eight full-time equivalent posts (four teachers and seven teaching assistants), one of which is currently vacant but will be recruited to.

    In response to the increased workload, the team has decided to refocus its efforts on specific groups of children, whilst building capacity in schools through a more systematic staff approach to training. This will be complemented by outreach services provided by special schools and integrated resources (IRs) to mainstream schools.

    Moving forward, the Autism Service will continue to provide targeted support for children at stages of transition (e.g. pre-school/Reception, Y6/Y7) and for those who are particularly vulnerable or at crisis point (e.g. at risk of permanent exclusion). Children with autism and related disorders who fall outside these year groups and categories will no longer be supported as a matter of course.

    The Autism Service will continue to collaborate with the Ryegate Children’s Centre, and will be notified when a child receives an autism diagnosis (subject to parental consent). However, children will no longer be automatically referred to the service following diagnosis. Referrals can be made by schools and parents, and will be accepted if the child meets the criteria for vulnerability described above.

    Last year, cuts to the community CAMHS budget caused waiting times to soar, with some young patients waiting up to 44 months to be seen. Local Asperger’s charity ACCT, with support from the Parent Carer Forum, successfully highlighted this issue with councillors and commissioners.

    Additional one-off funding was used to offer brief interventions and face-to-face triage to those already on the waiting list. According to NHS commissioners, this had the desired effect of reducing waiting times. All community CAMHS teams are now aiming to hit the 18-week referral-to-treatment target by April 2013.

    The new waiting list figures, however, do not include those youngsters whose referrals were “bounced” from CAMHS to MAST (Multi-Agency Support Team) – something that appears to be happening with increasing frequency, and not always appropriately. Inappropriate referrals cause frustrating delays for families, who then have to be re-referred to CAMHS. NHS commissioners are working to address this issue by developing clearer referral pathways and guidance for GPs.

    Feedback from parents also highlighted the lack of appropriate mental health services for older teenagers, who currently have to be discharged from CAMHS when they turn 16. We are delighted that a proposal to commission community CAMHS up to the age of 18 is being considered as a priority for the next financial year. Commissioners are working with providers of mental health services to try and reach an agreement on this. Subject to approval, the extended service would start operating during the second half of this year.

    Tell us your views!
    Do you think service managers and commissioners are responding to budget pressures in the right way? How will your child be affected? Please get in touch and tell us what you think. We will feed your views back to decision-makers.