10 - 2025-12-10 IJB - CAMHS and NDS Recovery and Renewal
North Lanarkshire Council · 10 December 2025
Back to Health and Social Care Integration Joint Board — 10 December 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 10 SUBJECT: CAMHS and NDS Recovery and Renewal Programme Board TO: Integrated Joint Board Lead Officer for Report: Maggs Thomson, Head of Health, NLHSCP Author(s) of Report Pauline Izat, General Manager, Specialist Children’s Health Services Unit, NLHSCP DATE: 10 December 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Pauline Izat ☒ Reviewed By: ☐ Endorsed By: ☒ 3. EXECUTIVE SUMMARY The report will give detail of scope and scale of modernisation that has been delivered by the CAMHS and NDS Recovery and Renewal Programme Board to facilitate delivery of a CAMHS and an NDS model aligned to the individual national specifications.
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2 4. RECOMMENDATIONS 4.1 It is recommended that the IJB PFA note contents of report and progress made to date. (1) Robust reporting is now available as an electronic patient management system with aligned electronic patient record is now in place. Performance is monitored and managed within the unit and formally reported via IQPR (2) All work streams have completed work initially advised with exception of capital planning. However, this work is in progress and can be managed locally with support from planning colleagues. Additionally, the information available to us, due to improvements in robustness of data capture is capable of informing redesign in a way that was not possible in first phase of capital investment. (3) The CAMHS and NDS Recovery and Renewal Programme Board has been stood down and programme of work is being taken forward operationally through a business as usual approach. The governance of approach is assured via monthly CAMHS Operational and Professional Group, CAMHS and NDS Quality Governance Group that meets monthly and a CAMHS, 8 weekly NDS Quality Governance Group and NDS Management Team Meeting. Assurance is provided via Partnership Governance structures North, Operational and Professional and North SCCG and MH QGG. (4) Continued review of performance is monitored via unit Performance Meeting and reported monthly via Integrated Quality Performance Report. 5. VARIATIONS TO DIRECTIONS? 6. BACKGROUND 6.1 In 2021, the Scottish Government Children and Young Peoples Mental Health and Wellbeing Taskforce published national specifications for Child and Adolescent Mental Health Services and Neurodevelopmental Services. Both specifications aim to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. These services are required to be available for all children and young people who are aged 0- up to 18th birthday. Yes Health Board ☒ No ☐ N/A ☐
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3 6.2 The Lanarkshire CAMHS and NDS Programme Board had been in place since 2021. The Programme Plan articulated how the National CAMHS Service Specification – as well as associated Scottish Government directives – will be locally implemented. The purpose of this programme was to assess, evaluate and where appropriate redesign Child & Adolescent Mental Health services ensuring a whole systems approach based on children and young people’s rights and relationships. 6.3 The board remains committed to delivery of safe, effective and child centred mental health care for children and young people across Lanarkshire who require support and intervention to manage their complex mental health challenge. 6.4 The strategic commissioning of CAMHS and NDS for the NHS Lanarkshire area is hosted by the North Lanarkshire IJB and managed by the North Lanarkshire Health and Social Care Partnership (HSCP). There was a change in SG funding commitment in third quarter of 2024. This reduced stability of budget. Funding deficit was strengthened by NHS Lanarkshire support. The current funding balance within Recovery and Renewal monies is £7,749,189. 6.5 A significant change to the CAMHS model was required to meet the national service specification. Plans were submitted to the Scottish Government outlining how it would be implemented. This specification focusses CAMHS on the needs of children and families affected by complex mental health problems, moving early intervention support to the Schools Counselling Model, School Nursing and the Community Wellbeing Framework. It also separated the request for assistance pathway for children and young people who primarily required assessment and diagnosis of neurodevelopmental disorders including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Intellectual Disability (ID), Foetal Alcohol Spectrum Disorder (FASD), Developmental Coordination Disorder (DCD) and Tourette’s and tic disorders. 6.6 In order to co-ordinate and monitor the delivery of the programme plan, North Lanarkshire HSCP established the CAMHS & NDS Recovery and Renewal Programme Board, chaired by the North Lanarkshire HSCP Medical Director and had support from a Professional Adviser from the Scottish Government. 6.7 There were 6 work streams within the Programme. These have all either been fully completed or are well progressed to a business as usual model of operational delivery: - Neurodevelopmental Service – all work completed. All neurodevelopmental requests for assistance are now channelled via established Neurodevelopmental Service. This combined 3 previous waiting lists (CAMHS, NDS and Paediatrics) and provided transparency of referral pathway, consistency of response and quality assurance of assessment. This is a highly
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4 skilled workforce and maximum efficiencies within resource are assured. Time limited commission of an external provider has provided additional capacity that facilitated assessments of young people before they graduated to adult service referral routes. Demand for assessment continues to exceed capacity. This has been highlighted nationally and is common across all health board areas. It is advised that national work will influence next steps with neurodevelopmental services. Choices & Partnership Approach (CAPA) Implementation within CAMHS- all work completed. This new model of patient management has been operational since May, 2023. It can now provide robust data capable of assuring planning of service capacity and informing trajectories over a longer time period. HR & Workforce – all work completed. A full review of workforce in line with CAMHS and NDS specifications was undertaken and professional and support staff gaps addressed. Communication and Engagement- all work completed. An Engagement Officer role has established a process that facilitates consultation with children, young people and their families. This provides assurance that the child’s voice is represented in our strategic planning and individual care planning. A website has been established and design of CAMHS and NDS logos were undertaken in partnership with New College Lanarkshire and decided by public vote. EHealth- all work completed. Trakcare build completed to facilitate delivery of CAPA Model. Electronic case record now in place across whole service. Capital/Strategic Planning- ongoing. Large scale refurbishment delivered in South Lanarkshire. Work ongoing across 3 sites in North Lanarkshire to deliver same. The main objectives of the Programme were: - Review CAMHS referral and assessment pathways with a view to implementing the Choices and Partnership Approach (CAPA) model. Full implementation of the Child and Adolescent Mental Health Service (CAMHS) Specification – Community CAMHS. Clearance of any backlogs on waiting lists for CAMHS. Clearance of any backlogs on waiting lists for Psychological Therapies. Agree a workforce model to utilise the funding provided by the Mental Health Recovery Fund to enable the effective implementation of CAPA Engage all key stakeholders to achieve consensus and clarity and enhance communication of new ways of working across all CAMHS teams and Neurodevelopmental Pathway. 6.8 The IJB should be assured that the objectives initially set by Programme Board have been realised and have now progressed to a stage of sustainability of performance and quality assurance that is aligned with national specification. 6.9 The performance trajectory is positive. A Referral to Treatment Target (RTT) of 90% was delivered for the first time in September of 2024. This has been consistently maintained since then with exception of October 2024(89.34%) and December (86.84%).
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5 6.10 There is a difference in recording of performance within CAMHS and LD CAMHS. LD CAMHS is managed within MH Directorate and they measure RTT to delivery of Psychological Therapeutic Interventions (PTT). The variance in this approach has become increasingly evident as universal CAMHS performance has improved. This is being reviewed locally. Currently CAMHS have no children or young people waiting beyond 18 weeks to be seen. We have sought Scottish Government assurance that they remain happy for reporting of RTT to continue to date of first appointment. This has been provided. 6.11 Additionally, we continue to work with West of Scotland colleagues to deliver a standard of care provision capable of managing care locally and consistently to facilitate equity with other health board areas. This has included expansion of our unscheduled CAMHS (UCAMHS) model. It has combined the expertise of CAMHS Duty Team, Intensive Treatment Team and Nurse Team. Hours of service delivery were extended in October 2024. The service is available Monday to Friday between 8am and 8pm. The Intensive Treatment Team is available during hours of 9-5 over weekend. This additional capacity and expertise has supported admission avoidance, care planning, safe hospital discharge and management of risk appropriate to environment. The UCAMHS response model is available to all children and young people on both CAMHS and NDS lists who experience deterioration in mental health whilst waiting to be seen or awaiting specific treatment. This service is also open, by referral, to any child or young person previously unknown who has presented with an acute deterioration in mental health with aligned escalation of risk. 6.12 CAMHS will continue to work towards delivery of a Psychological Therapeutic Therapy target of 90% that will bring RTT and PTT performance into closer alignment. This will be of benefit to the overall experience of the child and their family and/or carers. Work to date has included a review of all waits within CAMHS. Amongst the longest waits we have identified a cohort of YP who historically would have been accepted within CAMHS but would now be diverted to the NDS for assessment. Additionally, there is a group of YP who require a neurodevelopmental assessment but require additional therapeutic interventions. In response:- A waiting list cleanse and validation has been undertaken Specialist PRL appointments have been allocated as partnership appointments within CAPA model of appointment allocation. A Group has been established to address specific waits for anxiety support. The group(s) will provide evidenced based group psychological therapeutic intervention that support reported anxiety challenges experienced by a significant number of YP who remain amongst our longest waits beyond their initial assessment. Progress will be monitored via unit Performance Management Meeting and reported via Integrated Quality Performance Board.
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6 Identification of underspend monies secondary to vacancies that have supported additional capacity provision ( overtime and additional hours). PHS colleagues will continue to support with modelling of trajectory. 6.13 Our Neurodevelopmental Service continues to face challenges of long waits. The waits in Lanarkshire are transparent as they have all been collated on 1 waiting list since October of 2022. This is not true of all other Health Board areas. Positively, we are starting to see evidence that the referral rate to the service has slowed since 2022. Our Neurodevelopmental Service Lead is a key member of a national task force focussed on sharing of learning and good practice. The service has established a Whole School Approach model that has been based on a previous Tests of Change. This approach was able to evidence assessment capacity efficiencies without any reduction to assurance of assessment quality. It has been collaboratively developed with education colleagues and will commence in January 2026 with a plan to double the capacity of team by commencement of new school year in August 2026. 6.14 The Neurodevelopmental Service has a waiting list of 10,122 children and young people. Demand consistently outstrips capacity by approximately 40%. Additional capacity has been implemented by paid overtime. A proposal is in progress to support anticipated further capacity challenge due to number of upcoming maternity leaves. This would reduce capacity by a further 27%. 6.15 The demand for dietetic input support via NDS has grown a waiting list of 529 patients. 7. SUMMARY OF KEY ISSUES 7.1 Financial instability continues to challenge workforce stability. Much of funding being used to deliver scale of change needed was provided via Recovery and Renewal funding route and has required NHS Lanarkshire support throughout this financial year due to a centralised reduction from SG. 7.2 The Neuro Developmental service works independently of CAMHS. Demand continues to significantly out strip capacity of service. The trajectory will continue to widen if resource not made available to address directly. Referrals and demand are in line with other HB areas. Support within school is based on assessment of need not diagnosis. 7.3 Increasing complexity is both anecdotally and formally reported. Care assurance work is being undertaken in response to learning from significant adverse events. This includes assurance of consistent process in relation to mental health assessment; risk assessment; care planning and risk management. Training was undertaken across all staff groups to support
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7 implementation of this consistent process. Care assurance reporting framework planning is in process and is reported via CAMHS and NDS Quality Governance Group and onwards for assurance via HSCP Support Care and Clinical Governance meeting and via MHLD and Addictions for information. 7.4 Continuance of trajectory and ongoing performance is reported via CAMHS Performance Meeting and reported via the Specialist Children’s Unit Management meeting. 8. CONCLUSIONS 8.1 The initial aims of CAMHS and NDS Recovery and Renewal Programme Board have been delivered. It is acknowledged that performance against target remains fragile due to instability of finance. However, there is now clear evidence available that can assure efficiency of service delivery aligned with monies available. 8.2 The second phase of improvement work is underway to align the RTT and PTT Performance targets to a closer position. 8.2 Assurance of performance and quality of service delivery have become embedded within reporting structures aligned to operational and clinical governance structures. 8.3 Financial stability will be a focus of ongoing work within CAMHS and NDS Programme Board to ensure models that have been built remain sustainable within current funding envelope. 8.4 The IJB should note that the formal Programme of Works Steering Group has now been stood down. The operational, financial, clinical and performance governance is being managed from a business as usual position and reported via established governance structures. 9. IMPLICATIONS The implications of additional work stream will be minimal as initial objectives have been delivered. Planning will be required to ensure changes made are sustainable despite financial pressures. 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐
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8 People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A x 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Level 3 High Pauline Izat 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes Wide range of professional stakeholders attend Programme Board meeting. ☐ Provide stakeholders with information on how to get involved This is provided to CYP and families via our engagement officer and encouragement to use Care Opinion
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9 ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Our Engagement Officer has provided a range of opportunities for CYP and their families to provide feedback on service delivery and service planning. This can take form of focus groups or 1:1 ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services A CYP questionnaire that rates service delivery is undertaken annually ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Our Engagement Officer provides update to our CYP and families of what changes have been made due to their input. ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership Contribute to wider organisational stakeholder engagement processes (UNCRC etc.) 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A Requires review and update to reflect UNCRC EQIA added to website: Yes No N/A
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10 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Claire Rae, Chief Officer. Members seeking further information about any aspect of this report, please contact the following; pauline.izat@lanarkshire.scot.nhs.uk Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB
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11 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed