CAMHS - Neurodiverse CAMHS Team Waiting Times and Mitigation Plans Update FINAL
North Ayrshire Council · 13 November 2025
Back to Integration Joint Board — 13 November 2025 and its agenda
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Integration Joint Board 13 November 2025 Subject : Child and Adolescent Mental Health Services (CAMHS): Neurodiverse CAMHS Team Waiting Times and Mitigation Plans Update Purpose : This is presented for awareness and discussion Recommendation : Is it recommended that the IJB: a) Notes the current pressures, emerging risks and scope of re-design work undertaken in relation to Neurodevelopmental pathways for children and young people. b) Notes the Continuous Improvement of the CAMHS service and the development of options for a pan Ayrshire diagnosis and treatment model of care for neurodivergent Children and Young People, that sits separately to a Tier 3 CAMHS service. Noting that this service would require investment which is not currently available. c) Notes the clinical, operational and reputational risks associated with the current situation – that being the absence of a diagnostic or assessment service for those who don’t meet the N-CAMHS service specification. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership 1. EXECUTIVE SUMMARY 1.1 Referrals for children and young people seeking a neurodevelopmental diagnosis in NHS Ayrshire and Arran have increased considerably in the past five years. The waiting list for the Neuro CAMHS service now exceeds 2,441 with maximum waits of 3 years and 6 months. In the absence of further resource intervention, projected waits could reach 10 years, which would mean that a child referred in 2025 might not be assessed before leaving school or reaching adulthood.
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NHS Ayrshire & Arran implemented the National CAMHS Service Specification in August 2023, meaning that only children and young people with a co-occurring moderate to severe mental health condition are accepted to CAMHS. The Implementation of the National CAMHS Specification report, presented to the North, South and East Ayrshire Integration Joint Boards (Appendix 1 – North IJB report 16th March 2023) noted that while the National CAMHS Service Specification had been implemented, there was no investment or funding to deliver the corresponding National Neurodevelopmental Specification. The paper highlighted the resulting service gap for children and young people requiring neurodevelopmental assessment who do not meet the CAMHS criteria and confirmed that each IJB is working collaboratively to develop local pathways and a new Pan Ayrshire model to develop proposals to address this unmet need, through both better use of existing resources and pathways and developing options for service development, including diagnostic capacity, if and when funding or investment is available. 1.2 Since full implementation of the National CAMHS Service Specification in August 2023, only those young people with co-existing moderate-to-severe mental health conditions are accepted to CAMHS. To date, 560 referrals have been screened as non-specification and informed about the Neurodevelopmental Empowerment & Strategy Team (NEST). While this ensures compliance, it also highlights significant unmet diagnostic demand, which is reflected in the rise of complaints, FOIs and MSP enquiries relating to neurodevelopmental waiting times and access pathways. 1.3 The IJB is asked to note the current pressures, emerging risks and the scope of the redesign work undertaken. NHS Ayrshire and Arran and the IJBs are not alone in the management of this response to a universal population wide Public Health referral demand with evident national challenges in addressing demand and unmet need for children and adults for neurodevelopmental assessment, diagnosis and support. The Health, Social Care and Sport Committee are undertaking an ongoing inquiry and more recently a new Children and Young People’s Neurodevelopment Taskforce has been established. This cross-sector group has been set up to drive forward work identified to improve, and support implementation of the Children and Young People’s Neurodevelopmental Specification following a review into its implementation. 2. BACKGROUND NHS A&A CAMHS service redesign during 2021-2025 has introduced new roles, urgent care pathways and digital innovations. CAMHS have worked closely with Benson Health to develop a DCAQ model to inform the redesign of the service by analysing information and data from Care Partner and Trak Care.
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Phase one of the redesign was to understand the referral patterns into the service to support workforce redesign and innovation. This resulted in the creation of new roles to help alleviate the shortages of clinicians able to prescribe with the creation of Advanced Clinical Nurse Specialists (ACNS) and Pharmacy prescribers. The creation of CAMHS Urgent Assessment Intensive Treatment (CUAIT), the unscheduled team, means that there is a 7 day a week service 8am – 8pm which did not previously exist. Appendix 2– Redesign work in CAMHS provides further detail. A CAMHS Participation Officer ensures that young people family/carers are fully involved in the redesign of services and have their voices heard in terms of making improvements. The snapshot below from the Benson dashboard provides an illustration of the performance management framework and oversight in place for CAMHS services in Ayrshire and Arran. Mental Health Outcome Framework funding was utilised to support the development of the unscheduled care team and to work through the waiting list of young people waiting on the neurodevelopmental list. NHSA&A started to implement the National CAMHS Specification in February 2020 culminating in the full implementation by the 1 st Aug 2023. A Pan Ayrshire Neuro Event was held on the 16th Feb 2023 led by Glasgow University. A number of Pan Ayrshire public engagement events have been held 2023-25 with a communications plan and approach in place to advise of the changes to referrals and input for families already on CAMHS list.
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Since the implementation in August 2023 there have been 560 young people referred to CAMHS who do not meet the specification as laid out by Scottish Government. These young people and families have been sent a standardised letter explaining this which contains further information on services and resources available as delivered by Neurodevelopmental Empowerment and Strategy Team (NEST). It is important to note that in addition to the 560 young people who have been referred and do not meet the specification, there is a potential significant unknown number of children and young people who require a neurodevelopmental assessment but have not been referred as the referrer has been aware of the criteria and has nowhere to refer to in the absence of a neurodevelopmental assessment pathway out-with the CAMHS criteria. There are increasing challenges associated with prescribing and shared care arrangements following ADHD diagnosis. A proportion of children and young people are assessed privately or transition to adult services before prescribing arrangements are in place. There are currently no shared care arrangements within NHS Ayrshire & Arran for prescribing following a private ADHD diagnosis undertaken outwith N- CAMHS or an NHS-private provider commissioned diagnostic service. In these cases, prescribing and ongoing monitoring remain the responsibility of the private clinician, and families must meet these costs privately. Where diagnostic assessments are undertaken by a provider commissioned by NHS Ayrshire & Arran, shared care arrangements are in place whereby General Practitioners prescribe under the guidance and clinical monitoring of CAMHS. Guidance and a Service Level Agreement (SLA) have been developed to support GPs in implementing these arrangements safely and consistently. Engagement with service users has highlighted the strain that private prescribing places on families and the inequity it creates in access to treatment. The national shortage of ADHD medication, which lasted approximately 13 months, further limited the service’s ability to initiate new prescriptions during this period, creating additional backlog pressures that continue to be addressed. Work is ongoing with other NHS Boards and national colleagues to identify sustainable prescribing solutions and support the continued development of neurodevelopmental services across Scotland. The Health, Social Care and Sport Committee are undertaking an enquiry focussed on - Attention Deficit and Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) Pathways and Support Inquiry. The inquiry seeks to: • understand why waiting times for diagnosis and management of ADHD and ASD are reportedly long, including the drivers of increasing demand • understand how these conditions are diagnosed and managed • understand the impact of delays on individuals • explore solutions to improve capacity of services, referral pathways and support
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The inquiry will consider the following in relation to neurodevelopmental pathways for ADHD and ASD: • referral pathways • assessment, criteria and treatment thresholds • waiting times • "waiting well" and support pre-diagnosis • transitions between services • funding • workforce • the impact on individuals of receiving a diagnosis or waiting for a diagnosis A response was submitted to the committee in review to a call for views - a copy of this is included as Appendix 3. Thelma Bowers attended the Committee in October 2025 to give evidence on ADHD and ASD Pathway Support. The Committee focus was on the national growing issue of increasing demand and lack of capacity to access an assessment and/or treat neurodevelopmental conditions. Whilst this report focuses on children and young people, there is a recognised transition risk as individuals reach adulthood while still awaiting neurodevelopmental assessment. This has consequential impacts on Adult Community Mental Health Teams (CMHTs), which currently have no dedicated resource or funding to provide neurodevelopmental assessment or follow-up care. Work is therefore underway to develop a pan Ayrshire business case and service model to address this gap across Ayrshire and Arran, however the successful implementation of any future model is reliant on investment and funding being made available. 2.2 ASSESSMENT Waiting Times and Referrals Referrals to CAMHS continue to increase, with the main reasons for referral being anxiety. The service has seen an increase in referrals of 284% in the period (2019- 2024). The graph below illustrates the waiting list growth for Neurodevelopmental support via CAMHS showing that it has quadrupled from 628 in 2020 to 2,441 in 2025 with the longest wait currently 3 years and 6 months
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The children and young people currently on the waiting list will progress for further planned Neurodevelopmental assessment around autism spectrum disorder (ASD) attention deficit hyperactivity disorder (ADHD), exposure to alcohol and/or substances, Learning Disability, multiple diagnosis, whilst also considering alternative formulations including developmental trauma, attachment and relational difficulties. The graph below shows that ADHD accounts for around 50% of cases and a rise in dual ADHD/ASD presentations. There has also been an increase in dual ADHD/ASD cases with these complex presentations making throughput slower. • 37% of those waiting are under 12 years and 24 % are 14 years and above; • one in three are projected to turn 18 before assessment. • There are currently 174 young people aged over 18 years who remain on the Neurodevelopmental CAMHS waiting list with the oldest being 20 years old. • CAMHS do not operate an out of age policy, so will conclude all assessments if they are on the waiting list. This is expected to be approximately 33% of the waiting list by 2028. • 10-12% will likely transition into adult services which will have an impact on Adult Community Mental Health Teams.
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DCAQ modelling predicts that the waiting list will extend to 8–10 years by 2028 without additional capacity. Referral Pattern and Demand The referral pattern highlights the geographical variation across East, North and South Ayrshire between 2019 and 2025 with North showing the highest percentage of referrals followed by South and then East. The change to the National Specification reflects the reduced referrals in certain areas due to the absence of a universal diagnostic service. Additional information includes a notable: • Source shift: Schools ↓ from 67 % (2020–23) to 25 % (2024–25); GPs ↑ from 24 % to 63 % due to Specification change. However, this data reflects the reduction in referrals from education following the specification being implemented where previously schools were encouraged to undertake the referral to CAMHS for a Neurodevelopmental presentation. • Geographical variation: North +365 %, South +309 %, East +200 % since 2019/20 • Non-specification referrals: Audit (Nov 2022–Feb 2023) showed 69 % of ND referrals had no co-existing moderate-to-severe mental health condition, therefore not meeting CAMHS criteria. These cases consume substantial time in triage, screening, and communication, diverting specialist capacity from those meeting criteria. In 2024-2025 CAMHS received; 44 formal complaints, 71 telephone /informal complaints direct to service. Also notably from February 2025, 47 FOI’s and 84 MSP enquiries. The service meets with NHS A&A complaints department on a regular basis and the leadership team meet every Monday to action any complaints. An established complaint, FOI, MSP database has been set up to record, monitor and
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respond within the team. This has enabled the service to identify emerging themes and resulted in the development of standardised letters and a frequently asked questions leaflet. Additional Pressures In addition to delivering scheduled CAMHS and N‑CAMHS assessments a substantial proportion of clinical and managerial time is spent on essential activity that is not captur ed in RTT figures. This non-RTT activity equates to an estimated 15–20 % of total clinical capacity, representing significant opportunity cost across the system. The summary below describes in more detail the activity, volume and impact. Area of Activity Description / Indicative Volume Impact / Value Referral Screening and Triage > 560 referrals screened since Aug 2023 (20–40 min each) Ensures compliance with Specification and equity of access Clinical Decision Support for External Assessments ≈ 200 cases prepared for Helios/Purple House (30–60 min each) Enables safe commissioning and quality assurance Participation in Multi- Agency Panels and Transformation Work Regular input to HSCP panels, ND Implementation Group (~ 0.5 WTE weekly) Supports whole-system redesign and prioritisation Complaints, FOI and MSP Enquiries 44 formal, 71 informal, 47 FOI and 84 MSP enquiries (2024– 25); 45 min–2 hrs each Promotes transparency and learning QUALITY/PATIENT CARE 2.3 The absence of a dedicated wider neurodevelopmental pathway creates a clinical and reputational risk to NHS AA and the 3 Health & Social Care Partnerships. NHS AA are not alone in this position which is shared across many other Boards and HSCPs with work to improve this being highlighted at a national level. The quality-of-service delivery is also monitored with feedback from children and young people utilising KIDSCREEN which is a health related self-assessment quality of life questionnaire for children, young people and parents . A Quality Improvement Lead and Participation Officer are based within the service to support service improvement.
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3. PROPOSALS 3.1 Collectively, these activities represent essential work that maintains safe clinical governance, quality assurance, and effective partnership functioning across CAMHS and N-CAMHS. CAMHS continue to maximise clinical impact within existing revenue resources, utilising Recovery and Renewal and Mental Health Outcomes Framework (MHOF) funding to support workforce training and the development of a multi-disciplinary approach to assessment and treatment. Investment in the West Road premises has co-located the Neurodevelopmental CAMHS team, improving efficiency through dual- clinician assessments, reducing travel, and enhancing access to shared clinical and physical health facilities, including ECG and phlebotomy. The service is also piloting digital innovation through the Brain Gaze proof-of-concept, using eye-tracking and cognitive biomarkers to support ADHD and related assessments, with the aim of reducing assessment times and providing objective data. Further investment across the three Health and Social Care Partnerships (HSCPs) has strengthened the Neurodevelopmental Empowerment and Strategy Team (NEST), which provides early support and training for families. NEST also work with teams, services, organisations, third sector and community groups across Ayrshire providing training and awareness raising for the workforce and communities who serve our neurodivergent children/young people and families. Previous MHOF funding enabled the temporary commissioning of external providers to undertake neurodevelopmental assessments and reduce the waiting list backlog; however, there is currently no ongoing funding available to continue external commissioning, creating a sustainability risk without further investment. Ongoing development of an outline business case for a pan Ayrshire ND Diagnostic Service which will sit separately from CAMHS, this should be concluded by the end of 2025. The business case will outline options appraisal including investment and a preferred model for a new Neuro-developmental service for children and young people who do not have co-morbid mental health concerns, this requires further investment. Due to ongoing difficulties in recruiting Consultant Psychiatry, CAMHS have developed extended roles including Advanced Clinical Nurse Specialists (ACNS), Pharmacist Prescribers and a GP with Special Interest within the Neurodevelopmental CAMHS team. CAMHS have also provided training and supervision to allow nurses to undertake the ACNS training from within the service including diagnostic assessment, physical health assessment and prescribing. This can take between 12 and 18 months to complete. The ACNS provide a dual role of diagnostic assessment and prescribing of medication
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The Psychiatry complement has increased to 3.5 following success Consultant CAMHS Psychiatry recruitment and routinely the majority of their caseload sits within the Community CAMHS and CUAIT. A Quality Improvement Lead and Participation Officer are based within the service to support service improvement. Development of post graduate training by NES and Universities across Scotland is ongoing and the staff team within CAMHS have supported the development of the education resources aimed at a wide range of audience. Implementation of local GP prescribing guidance and reinforcement of shared care protocols through the Area Drug and Therapeutics Committee (ADTC). Inclusion of prescribing capacity and pathway development within the Outline Business Case (OBC) for the pan-Ayrshire Neurodevelopmental Service, including recruitment and training of prescribing pharmacists and specialist clinicians to strengthen safe and sustainable prescribing practice. Ongoing oversight through the Neurodevelopmental Implementation Group to ensure consistency, safety and clinical governance across the system. 3.2 Anticipated Outcomes The Ayrshire and Arran CAMHS Service is now fully aligned to the National Specification, the work outlined in the report describes the focus to utilise existing resources creatively and to best effect in the absence of a pathway for children and young people that don’t meet the CAMHS specification but require Neurodevelopmental Support. The development of the Pan Ayrshire Business Case will describe the pathways and workforce model required to meet the current and projected need and demand and will set out the investment required. It is anticipated this can be used to influence and shape any future national direction and resource allocation. 3.3 Measuring Impact Quantitative: • Impact on waiting times through co-location and digital solutions, number of assessments completed, diagnostic accuracy Qualitative: • Staff focus groups to capture perceived benefits of co-location, MDT collaboration and new advanced roles. • Children, young people and family feedback on accessibility, experience and quality of care.
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4. IMPLICATIONS 4.1 Financial As noted there remains no dedicated or recurring funding to implement the National Neurodevelopmental Specification, and current mitigation activity is being delivered within existing CAMHS resources. 4.2 Human Resources Workforce constraints remain a key determinant of waiting times and service sustainability. Neurodevelopmental CAMHS have 9.35 WTE clinicians comprising of Psychology, ACNS, Mental Health Nurses, Occupational Therapists, Speech and Language Therapists currently providing assessment and diagnosis across Ayrshire & Arran, the staffing complement is 12.35 WTE for the diagnostic team which is complemented by 3.2 WTE clinicians who provide ongoing pharmacological and nonpharmacological interventions. (Pharmacists and Music Therapist). Recruitment and retention with Neurodevelopmental CAMHS is impacted by the competitive pay and conditions offered by the private sector for highly trained clinicians. This can be evidenced with Band 7 ACNS being offered a Band 8C pay salary with all of the conditions available to them within the NHS. 4.3 Legal “None”. 4.4 Equality/Socio-Economic Allocation is made from waiting lists in chronological order to provide equity. In recognition of complex mental health and neurodevelopmental priorities are cognisant of this. Any requests for prioritisation are discussed in a multi-disciplinary review with representation from each of the teams. A review of referral criteria including the guidance for prioritisation is currently in progress. Referral patterns by SIMD and HSCP are monitored through Benson Wintere dataset to address inequity. 4.5 Risk The current neurodevelopmental waiting list within CAMHS, with the longest wait at 3 years and 6 months presents significant clinical risk. Delayed diagnosis contributes to unmet need, deterioration in young people’s wellbeing, and reduced capacity across CAMHS, education and social care systems, often leading to escalation through crisis pathways and a variety of whole system costs. There is also a transition risk as a number of young people reach adulthood while still awaiting assessment. This creates additional pressure on Adult Community Mental Health Teams (CMHTs), which currently have no dedicated resource or funding to provide neurodevelopmental assessment or ongoing care.
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Prescribing responsibility and continuity following ADHD diagnosis present a further governance risk. Shared care arrangements with General Practitioners are inconsistent, and Adult Community Mental Health Teams (CMHTs) and CAMHS are not resourced to provide ongoing prescribing or monitoring unless patients meet referral criteria. This can result in delays to medication initiation or continuation post- diagnosis, increasing the risk of treatment interruption and inequity of access across Ayrshire and Arran. A range of mitigating actions are underway to reduce the projected 10-year wait. These include: • Workforce expansion through recruitment and training of Advanced Clinical Nurse Specialists (ACNS), Allied Health Professionals and Pharmacy Prescribers. • Digital enablement through the Brain Gaze pilot. • Co-location and process redesign at West Road to increase throughput and efficiency. • Referral management and redirection to NEST to reduce inappropriate inflow. • Development of a pan-Ayrshire Neurodevelopmental Diagnostic Service through an Outline Business Case (OBC), outlining the model and capacity which will be capable of delivering the required number of assessments per year to address the current backlog and future prevalence – noting there is no funding currently available to support a new service development. • Implementation of local GP prescribing guidance and reinforcement of shared care protocols through the Area Drug and Therapeutics Committee (ADTC). • Inclusion of prescribing capacity and pathway development within the Outline Business Case (OBC) for the pan-Ayrshire Neurodevelopmental Service, including recruitment and training of prescribing pharmacists and specialist clinicians to strengthen safe and sustainable prescribing practice. • Ongoing oversight through the Neurodevelopmental Implementation Group to ensure consistency, safety and clinical governance across the system. 4.6 Community Wealth Building “None” 4.7 Key Priorities The IJB and NHS Ayrshire and Arran are delivering on the CAMHS Specification and challenges remain with mirroring this for the Neurodevelopmental Specification. It has been over two years since the decision to protect the CAMHS service and revert to alignment with the National Specification and work has progressed over this period to develop new pathways and models of care. This is a complex issue demonstrated in the time and effort to conclude the whole system programme of work which remains ongoing.
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5. CONSULTATION The HSCP are committed to involving and engaging external stakeholders to shape future proposals including through stakeholder engagement sessions. CAMHS have worked closely with the three HSCP’s to develop the non CAMHS Neurodevelopmental business case along with the development of the support pathways for young people who do not meet the referral criteria for CAMHS. Pan Ayrshire Engagement Sessions and North Ayrshire specific engagement exercises have been undertaken and are ongoing both through NEST and through a programme of engagement work undertaken by the CAMHS and Mental Health engagement officers Caroline Cameron, Director Thelma Bowers, Head of Mental Health (thelmabowers@north-ayrshire.gov.uk) Appendices • Appendix No 1, IJB Report 16th March 2023 • Appendix No 2, Redesign work in CAMHS 2021-2025 • Appendix No 3, Health and Sport Committee NHS AA Response
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Appendix 1 Integration Joint Board 16th March 2023 Subject: Implementation of the National CAMHS and Neurodevelopmental Specifications Purpose: The report is for: Awareness Discussion Recommendation: IJB are asked to: Note the successful implementation in Ayrshire and Arran to meet the National CAMHS Specification, noting the ongoing demands and risks placed on the service of accepting referrals for young people that do not meet the national criteria and specification. Through the 3 HSCPs in Ayrshire and Arran take forward work at pace with partners to progress whole system plan(s) to meet the National Neurodevelopment Specification, noting approval that referrals not meeting the CAMHS specification will cease to be accepted by CAMHS from 1 August 2023. Direction Required to Council, Health Board or Both Direction to: No Direction Required North Ayrshire Council NHS Ayrshire & Arran North Ayrshire Council and NHS Ayrshire & Arran √ Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership ND Neurodevelopmental Diagnosis RTT Referral to treatment time N-CAMHS Neuro- CAMHS CAMHS Child and adolescent mental health services DNA Did Not Attend 1. EXECUTIVE SUMMARY 1.1 Child and Adolescent mental Health Services (CAMHS) are now aligned and resourced to fully implement the NHS Scotland National CAMHS Service Specification published in February 2020 CAMHS national service specification. The specification describes the role of CAMHS as providing access to multi- disciplinary teams that provide: Assessment and treatment/interventions in the context of emotional, developmental, environmental, and social factors for children and young people experiencing mental health problems. Training, consultation, advice, and support to professionals working with children, young people, and their families. This report provides an update on the implementation of the National CAMHS Specification, to ensure the IJB are aware of the progress and supportive of the
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work required with partner services in the development of Neurodevelopmental Services for children and young people where there is no co-occurring mental health presentation. This development both on a Pan Ayrshire basis and within HSCP areas is required to meet the National Neurodevelopmental Specification for Children and Young People: National Neurodevelopmental Specification for Children and Young People 1.2 The National Neurodevelopmental Specification is for children and young people who have neurodevelopmental profiles with support needs and require more support than currently available. These children are often referred to CAMHS but do not always meet the mental health criteria described in the CAMHS national service specification criteria. 1.3 Currently in Ayrshire and Arran the CAMHS service accepts referrals for young people requiring a Neurodevelopmental Diagnosis (ND) regardless of whether a mental health need is evident. This practice is not in alignment with other CAMHS services in Scotland and lacks alignment with the National Specification for CAMHS. The report outlines the impact on the CAMHS service in Ayrshire and Arran of continued acceptance of neuro referrals which do not meet the criteria, the significant increase in number of referrals and the critical risk this poses to the CAMHS service being able to deliver the core and unscheduled care CAMHS service. 1.4 To fully deliver CAMHS in alignment with the National service specification and ensure the service can maintain performance and clinical standards the service must start signposting referrals to alternative pathways for those young people who do not meet the service specification access criteria. These are largely for young people requiring a neurodevelopmental diagnosis in the absence of a mental health need which have historically been accepted before the national specification was developed and now account for significant waiting times within the CAMHS service. This is required to ensure safe service sustainability and to enable CAMHS resources to be allocated to young people with mental health needs in alignment with the CAMHS pathways developed by the Extreme Team reform work. There is a significant risk to the Ayrshire and Arran CAMHS service of continuing to accept referrals until August, it is likely that national performance targets for CAMHS waiting times will be breached as the service continue to accept referrals over the period required for the Neuro specification to be implemented. 2. BACKGROUND CAMHS Specification 2.1 Child and Adolescent mental Health Services in Ayrshire and Arran are now aligned and resourced to fully implement the NHS Scotland National CAMHS Service Specification published in February 2020 Child And Adolescent Mental Health Services: national service specification - gov.scot (www.gov.scot). This follows a significant amount of Reform work in the preceding 3 years and is a culmination of the combined work of the CAMHS Extreme Team and CAMHS Implementation group.
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The specification describes the role of CAMHS as providing access to multi- disciplinary teams that provide: Assessment and treatment/interventions in the context of emotional, developmental, environmental, and social factors for children and young people experiencing mental health problems. Training, consultation, advice, and support to professionals working with children, young people, and their families. In Ayrshire and Arran reinforced by Scottish Government investment for recovery and renewal for Mental Health there has been significant investment in the redesign and development of the service to meet the specification and the needs of the children, young people, families, and carers. CAMHS will offer assessment, treatment and care to children and young people experiencing moderate to severe depression, moderate to severe anxiety problems, self-harming behaviours, and other diagnosable mental health conditions where there is an indication for treatment and therapeutic care. Young people requiring CAMHS will present with mental health problems that are causing significant impairments in their day-to-day lives. Such presentations can result in both the need for scheduled and/or unscheduled care and to this end there has been investment in the development of an CAMHS Urgent Assessment and Intensive Treatment service that is now operating across seven days which complements the traditional core CAMHS service model. 2.2 A Neurodevelopment CAMHS service (N-CAMHS) has also been developed specifically for those children and young people whose Neurodevelopmental Disorder co-exists with a clearly defined and treatable mental–illness. This service offers specialist clinical support, assessment and diagnosis for children and young people experiencing the combined challenges of mental ill-health with conditions such as Autism or attention deficit hyperactivity disorder. 2.3 The CAMHS Extreme Team was commissioned in 2020 to respond to the Reform question: How will we improve Children and Young People’s Mental health and wellbeing with timely access to services and support to Children, young people, and their families at a locality level? The program of work undertaken by the Extreme Team at pace centered the reform question on delivery of the new CAMHS National service specification and delivered Transformation in key areas of enquiry over an intensive 6-month period and critically developed and defined: Three core CAMHS pathways: Core CAMHS delivery, Unscheduled Care CAMHS Neurodevelopment CAMHS Clarified the provision of psychological interventions and professional roles from CAMHS and Educational Psychology for Children and young people across the three Partnerships in Ayrshire and Arran.
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The Extreme Teams programme of work formally concluded in June 2021 with the achievements noted above. To ensure that these changes could be embedded and achieve consistency of service excellence across the whole system a CAMHS implementation group continued to meet with the same membership as the core Extreme teams. The focus of the work of the group over the last 2 years has been on the monitoring of recruitment plans, workforce modelling, waiting times for the Neurodevelopment service and review of the developing evidence base to inform ongoing development of the service and inform future planning in alignment with the service specification. In addition to the Extreme Team reform programme there have been other whole system developments which complement and enhance provision to the whole population and wider communities. Neurodevelopmental Specification 2.4 The Children and Young People's Mental Health and Wellbeing Taskforce reported in 2019 and recommended that Scottish Government and Partners should: "Develop a Neurodevelopmental Service Specification for use across services in Scotland". The National Neurodevelopmental Specification is for children and young people who have neurodevelopmental profiles with support needs and require more support than currently available. These children are often referred to CAMHS but do not always meet the mental health criteria described in the CAMHS national service specification criteria. 2.5 The Specification complements, and sits within, the Getting It Right for Every Child approach. It reflects the principles of UNCRC, the Universal Health Visiting Pathway, and Ready to Act for Allied Health Professionals. The Specification aims 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. 2.6 The Specification outlines that children, young people and their families will be able to access additional support, appropriate for their neurodevelopmental needs, through universal services, such as via the named person, and community based mental health and wellbeing supports and services. Universal services should work closely with professionals working in neurodevelopmental services, relevant health and social care and education services. These professionals should be linked with CAMHS so that children and young people with both neurodevelopmental and mental health support needs can get the additional support they require. 2.7 Professionals providing support will also provide assessment, formulation, recommendations, and where appropriate and helpful, diagnostic assessment for those children and young people to help them understand their neurodevelopmental differences and support needs. Understanding of support needs can be enhanced by diagnosis but should not wait for diagnosis. The National Neurodevelopmental Specification sits along the Service Specification for CAMHS and the same principles underpin both specifications. There are 7 standards of care set out to provide the minimum stand of care expected from neurodevelopmental services. These are: High Quality Care and Support that Is Right for Me 1. I am fully involved In the Decisions about my Care
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2. I will receive High Quality Assessment, Formulation and Recommendations that are right for me 3. My Rights are acknowledged, Respected and Delivered 4. I am fully involved in Planning and Agreeing my transitions 5. We fully involve Children, Young People and their Families and Carers 6. I have confidence in the Staff who support Me 2.8 Across Ayrshire and Arran the requirements of the Neurodevelopmental Specification have not been implemented or met. In order to achieve a whole system approach the neurodevelopmental specification needs to be cross sector and involve health, education, social services and the third sector. The specification sits as part of a whole system, with a single point of access, whereby health, education, social services and third sector professionals actively seek to understand each other’s unique contributions and respect each other’s areas of expertise. A stepped and matched care pathway is needed so additional supports for example from CAMHS can be accessed as needed, this stepped support from CAMHS is in place in Ayrshire and Arran with the establishment of the Neurodevelopment CAMHS service. 2.9 Professional staff supporting the implementation of the neurodevelopmental specification will include registered children’s professionals with additional training in the identification, assessment and formulation of neurodevelopmental conditions, including: Speech and Language Therapists General Practitioners Paediatricians Occupational Therapists Peripatetic Teachers Educational Psychologists Nurses Clinical Psychologists Social Workers Children and Adolescent Psychiatrists Physiotherapists This illustrates the whole system approach and range of professionals required to support young people.
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A timely response to requests from families and carers who have concerns about their children’s neurodevelopmental profiles and needs can reduce family and carer stress, improve confidence in adopting positive and supporting parenting approaches, and receive support, guidance and interventions that are tailored to the needs of their children, increasing the prospects of early improvements in outcomes. It is nationally recognised that the implementation of the neurodevelopmental specification will reduce the numbers of children and young people referred to CAMHS, and rejected, as they do not meet the CAMHS referral mental health and risk/impact criteria. In Ayrshire and Arran to date the CAMHS service has not rejected any referrals for young people where there is a query of a Neurodevelopmental Disorder or a request for diagnosis. Impact on CAMHS Service in Ayrshire and Arran 2.10 The key performance standards that the service are measured against and is required to provide is our Referral to Treatment (RTT) for all referrals. It is required by Scottish Government that every child or young person referred to CAMHS is assessed and receives a form of treatment and intervention within 18 weeks of that referral. Ayrshire and Arran CAMHS continue to meet more than the 90% compliance against this target. The achievement of this target however continues to present challenges in the context of increased referrals and demand which has doubled between 2022 and 2023 compared to previous years of referral activity. 2.11 The increasing trajectory and trend of referrals to CAMHS since June 2022 has shown no sign of abating which also peaks over holiday periods. This can also be compounded by unprecedented number of DNA’s resulting in significant backlog in children and young people awaiting assessment. Between June and August 2022 there was a 20% DNA Rate in which one in every five assessments were not attended. An assertive recovery mitigation plan was developed by the service leadership and management team to respond to this increased demand and reduction in waiting time performance. The projected wait time in October for November/ December if remaining unaddressed, would have resulted in a potential reduction in performance to as low as 14% compliance equating to a wait of 91 weeks. The recovery plan was implemented in early October 2022. The results reported in January 2023 for December’s position is 96.5%, based on scheduled appointments January RTT% is projected at 99% with February at 100%. Appointments have not been allocated for March 2023 at the time of writing. The waiting list as of 31 December 2022 has only 2% breached and 98% waited less than 18 weeks. 2.12 The key area of challenge in the context of service reform remains the high demand and subsequent long waiting time for Neurodevelopmental (ND) diagnosis. CAMHS currently accepts referrals for young people requiring a ND assessment regardless of whether a mental health need is evident. This is currently practice which is not in alignment with other CAMHS services nationally and lacks alignment with the CAMHS National service specification.
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Figure 1 below shows the trend in referral to CAMHS for ND difficulties and the increase over time. Figure 2 below shows the ND referrals compared to referrals for other reasons to CAMHS. Figure 3 below shows that 69% of young people referred to CAMHS with ND concerns did not have a co-existing or suspected mental health difficulty. Figure 1: Referrals to CAMHS for ND difficulties from 2019 to 2022 Figure 2: The increased demand for CAMHS services from 2019 to 2022 comparing referrals for ND difficulties to other referrals. Figure 3 the proportion of referrals to CAMHS with ND difficulties with and without mental health difficulties.
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2.13 A telephone contact service has also been established to provide information and assist children and their families who are currently waiting for a diagnostic assessment. The specialist N-CAMHS team have completed 75 assessments for ND difficulties from November 2022 to February 2023. In January 2022 with Scottish Government recovery and renewal funding external provision was secured to assist with reducing the waiting time for a neurodevelopment diagnosis and CAMHS has subsequently commissioned two external providers: Purple House and Helios to manage the backlog of referrals. 180 young people were referred to Helios with 176 accepted in the year to February 2023. The contract with Purple House has been secured for review of 3 complex referrals per month. In the period January 2022 to end of February 2023, 44 young people were referred. The current waiting list holds non-Mental Health referrals of around 700 young people with a referral/waiting list management plan which will take 22 months to complete if the current use of external providers is maintained and the CAMHS specification is fully implemented immediately. The longer CAMHS continues to accept these referrals the greater the length of time required to address the long waits. 2.14 To fully deliver CAMHS in alignment with the National service specification planning requires to taken forward at pace to facilitate the signposting of referrals to alternative pathways for those young people who do not meet the service specification access criteria. This is required to ensure safe service sustainability and to enable the critical CAMHS resources to be allocated to young people with mental health needs in alignment with the CAMHS pathways developed by the Extreme Team reform work. The alternatives to this approach would compromise: Core CAMHS Delivery: Young people with moderate to severe mental health disorder such as depression, Anorexia nervosa and psychosis may not receive treatment. Without responsive treatment young people’s mental health may deteriorate, and long term prognosis will be impacted in some disorders such as psychosis. Increased risk of young people requiring hospital admission or OOH support as they are not receiving regular and effective support. A larger burden will fall on other services such as OOH services, ED, Police and other services such as school counselling and voluntary sector organisations. The RRT will increase and NHS Ayrshire and Arran CAMHS will no longer reach 90% compliance Unscheduled Care CAMHS Young people who have presented and been admitted to paediatrics or ED may not receive a mental health assessment from CAMHS. As young people have not received assessment including risk assessments there will be increased risk of a completed suicide or significant act of self-harm leading to life changing physical health difficulties such as liver transplant. A larger burden will fall on other services such as OOH services, ED, Police, and other services such as school counselling and voluntary sector organisations.
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Comprising either of these core CAMHS pathways carries an unacceptable level of risk for young people in Ayrshire and Arran. To fully operationalise the CAMHS specification ensuring appropriately deployed CAMHS resources and safe service delivery from the 1 August 2023 the CAMHS service will focus on delivering the CAMHS service specification as prescribed nationally. The CAMHS will continue to screen all referrals directed into the service to ensure that young people that are appropriate for CAMHS are accepted. CAMHS will continue to accept young people with a comorbid or existing mental health difficult along with their ND difficulties, supported by the N- CAMHS team. Neurodevelopmental Pathways 2.15 To fully operationalise the CAMHS specification ensuring appropriately deployed CAMHS resources and safe service delivery from the 1 August 2023 the CAMHS service will focus on delivering the CAMHS service specification as prescribed nationally and resourced locally. The CAMHS will continue to screen all referrals directed into the service to ensure that young people that are appropriate for CAMHS are accepted. CAMHS will continue to accept young people with a comorbid or existing mental health difficult along with their ND difficulties, supported by the N-CAMHS team.. 2.16 Together with the three HSCPs in Ayrshire and Arran plans require to be developed at pace with partners to progress whole system plan(s) to meet the National Neurodevelopment Specification. Specific outputs include: Communication plan to be developed to inform stakeholders about the change in provision and new service models Whole system development of alternative service or community wellbeing solutions for young people building on the good practice already being commissioned by Education and Children’s services across the whole system. Continue to deliver NEST as a universal life course service offer with whole system with whole system partner consideration to be given to build on this key service development and early intervention solution. Whole system consideration of the outcomes and recommendations of the Ayrshire Neurodevelopment Glasgow University event held early in 2023 to build on local good practice and a partnership approach to develop a comprehensive range of alternative provision. Neurodevelopmental Empowerment and Strategy Team (NEST) NEST is a new and first in Scotland service jointly funded by East, South and North HSCP’s in Ayrshire and Arran. This newly launched service provides co- ordination and development of pathways of empowerment for the large number of children and adults directly and indirectly affected by neurodevelopmental diversity across the three Ayrshire partnership areas which will deliver on three critical outcomes. Whilst not directly managed or within the CAMHS service provision, NEST complements the service redesign and aspirations that are outlined for CAMHS Neurodevelopmental services and there will be a natural synergy
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between the core service and this new emerging model, the core outcomes and benefits of which are noted below: Information access – Up to date, relevant and accessible information will be freely available for the neurodivergent community and professionals across Ayrshire. Individuals and families will have a good understanding of what a diagnosis means for them and will be able to make informed decisions. Empowerment Programme – Individuals and families/carers will have a better understanding of their neurodivergent differences and through the opportunity to learn, develop strategies and networks will be empowered to live as full a life as possible. The NSET team, in partnership with individuals, families and neurodevelopmental professionals will design and deliver a systematic pan Ayrshire, needs based empowerment programme. Existing communities and groups will be supported to increase their scope and reach across their area. Community/Services - Communities across Ayrshire will be more tolerant and understanding of the needs of neurodivergent individuals. This tolerance and understanding will provide a marked improvement in access and opportunity for neurodivergent individuals and families. Local services will be aware of the needs of our neurodivergent community and will systematically incorporate solutions to these needs into their service delivery. These core critical outcomes are being delivered through collaborative working with neurodivergent individuals, their families, clinicians, third sector and services across Ayrshire. This is a unique life span population wide universal service and an examplar across the rest of Scotland in building a cohesive lifespan pathway of supports to people with neurdivergent needs. The NEST service provides the building blocks and foundation in Ayrshire and Arran to taking forward the full implementation of the Neurological Specification. 3. Recommendation 3.1 IJB are asked to: Note the successful implementation in Ayrshire and Arran to meet the National CAMHS Specification, noting the ongoing demands and risks placed on the service of accepting referrals for young people that do not meet the national criteria and specification. Through the 3 HSCPs in Ayrshire and Arran take forward work at pace with partners to progress whole system plan(s) to meet the National Neurodevelopment Specification, noting approval that referrals not meeting the CAMHS specification will cease to be accepted by CAMHS from 1 August 2023.
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3.2 Anticipated Outcomes IJB has assurance that risks are identified and managed appropriately to ensure the safe and sustainable delivery of the National CAMHS Specification. Ayrshire and Arran will have a sustainable and world class CAMHS service that meets the needs of young people that require support under the national CAMHS service specification. Full alignment and compliance with the national CAMHS service specification with improved Children and Young People’s Mental health and wellbeing outcomes, timely access to services and support to Children, young people, and their families at a locality level in alignment with the CAMHS extreme team reform question. The positive delivery of a whole system Neuro-developmental Service in Ayrshire and Arran. CAMHS will be able to progress through the current Neurodevelopmental list more timeously and be able to offer more therapeutic interventions. Young people coming through N-CAMHS will be seen by the right person, in the right place at the right time. Opportunity for whole system partnership approach to developing alternative service or community wellbeing solutions for young people that do not need a CAMHS referral and building on the good practice already being commissioned by Education and Children’s services across the whole system. 3.3 Measuring Impact CAMHS can monitor the number of referrals that come to the N-CAMHS service and the referrals that are meaningfully redirected to more appropriate Partner Services. Benson Wintere has been commissioned since 2020 and is able to produce locality and school level information on referral activity, work force modelling, capacity, and demand with live dashboards to reflect service activity. This information is utilised to continue to inform service planning and workforce development. An engagement officer has been recruited by the service to facilitate young people in service design and inform service improvements. KIDSCREEN has been implemented with a digital approach to capturing quality of life and experience information. A follow up report will be presented to the IJB with progress and details of plans from a whole systems perspective across Ayrshire and Arran and also locally in our own HSCP/Local Authority area. 4. IMPLICATIONS 4.1 Financial Creating a Neuro-developmental Service for Children and Young People who do not meet the CAMHS Specification will require financial investment from system partners, as the model and pathways are designed and developed the financial implications will be quantified. 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic
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None 4.5 Risk Reputational and operational risk of CAMHS being able to safely meet demand if the Specification is not implemented. Risk implications of other functions that CAMHS would be unable to sustain are detailed in the report. There is a significant risk to the North Ayrshire CAMHS service of continuing to accept referrals until August, it is likely that national performance targets for CAMHS waiting times will be breached as the service continue to accept referrals over the period required for the Neuro specification to be implemented. 4.6 Community Wealth Building None 4.7 Key Priorities Meets Caring for Ayrshire, GIRFEC, The Promise, HSCP strategic objectives, Ayrshire conversation Mental Health priorities, Mental Health and wellbeing strategy. Delivery of a fully resourced and compliant CAMHS service in alignment with the national specification is a key national and local HSCP strategic priority. This will enable full realisation of investment for Children and Young people’s Mental health in Ayrshire and Arran, improving mental health and wellbeing and enabling timely access for young people and their families to the right service or support in the right place and the right time. It is a key priority of all Partners across the whole system to ensure that there are fully developed wellbeing services and supports for Children, young people, and their families and to enhance current models of best practice in relation to neurodevelopment diagnostic and support provision. This is evidenced by the initial investments by the three HSCP’s in the NEST service and Autism support Ayrshire which provide information, training and community supports at a population wide universal level. 5. CONSULTATION The work developed by the CAMHS Extreme Team and more latterly the CAMHS implementation group has been fully consulted as part of the programme of Whole systems Reform. There has been an event for all stakeholders on 16th February with Glasgow University and world experts to try and understand the alternatives for young people who would fall under the ND service specification. The proposals as outlined are supported by the three HSCPs and will be presented to all three IJBs. Caroline Cameron, Director, NAHSCP Thelma Bowers, Head of Service, Mental Health, thelmabowers@north-ayrshire.gov.uk, 01294 317849 Appendices None
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Appendix 2 Redesign work in CAMHS & CEDS 2021 – 2025 Introduction NHS A&A CAMHS have redesigned the entire service since 2021-2025 including creating pathways and distinct teams to ensure that young people are seen in the right place, by the right person at the right time. Workforce redesign and innovation has seen the creation of new posts to help alleviate the shortages of clinicians able to prescribe with the creation of Clinical Nurse Specialists and Pharmacy prescribers. The creation of CUAIT the unscheduled team with CAMHS means that there is a 7 day a week service 8am – 8pm which did not previously exist. (Appendix – Redesign work in CAMHS). A CAMHS Participation Officer was employed to ensure that young people family/carers are fully involved in the redesign of services and have their voices heard in terms of making improvements. Community CAMHS Team – 18 week Referral To Treatment NHS A&A CAMHS have continued to meet the 18 week RTT since 2022 and are one of the only health boards in Scotland to sustain this. Even in 2023 when the CAMHS National Specification was implemented the service increased the number of assessment appointments and continued to meet the target. The Community Team continue to use the data to stay ahead and inform us of future concerns. The appointment of a Data/Information Analyst is key to this as information is sent to the team leader on a bi-weekly basis. In October 2025 the Community Team streamlined the Nurse-led Medication clinics to ensure the regular monitoring of young people prescribed medication through the Community CAMHS Team.
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Driver Diagram above of the Nurse-led Medication Clinics CUAIT (CAMHS Urgent Assessment Intensive Treatment) Team In June 2022 the CUAIT became operational creating their criteria, setting up Care Partner forms and combining the mental health and CARAS risk assessments. There was an expansion of response to include Ayr Hospital ED, CAU Ayr and Crosshouse hospital 16- 18th birthday. Collaboration with health partners in AMHS, paediatrics and Arran/Cumbrae (pathways, response, sops). Collaboration with HSCP partners in East Ayrshire (WSA, CYJ). Between October 2023 and February 2024 the first recruitment of CUAIT’s first band 5 took place along with further band 6 recruitment (introduction of learning disability nurse in team). A duty escalation pathway was developed and the expansion of weekend role to include urgent review/follow up for known patients. During the period February 2024 and October 2025 a student nursing placement audit was carried out and the team were identified as a placement area. PREVENT training and right-wing ideologies training was rolled out across the team and a 12 hour shift pilot 8am- 8pm 7 days, closing referral gap between daytime and overnight services. The NHS24 pathway for up to 18th birthday supported by ICPNT was put in place and the ESMHP pathway supported by Psychiatric Liaison and MHANP. CUAIT Psychiatry 0.5 WTE was set up to work alongside the rest of the CUAIT team adding another complementary workforce skill mix element to the service. The CUAIT NDV pathway (under review as per PDSA cycle). ADASTRA training is planned and access to complete NHS24 process in its entirety. N-CAMHS • Workforce & Recruitment • Training & Skill Development • CYP Engagement Sessions with Participation Officer (Team Name and Logo) • Information Packs for CYP and Families • Prioritisation Criteria
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• Pathways of Care (e.g. ASD, ADHD, Multiple Presentation, Medication) • Documentation Review (e.g. Neurodevelopmental History, Screening Tools) • Transition Planning: Primary to Secondary Check-Ins • Waiting List Initiatives to Support Lengthy Waits: North Ayrshire School Project and East Ayrshire Clinic Model (Caring for Ayrshire: Providing the Right Support at The Right Time Close to Home) • Use of External Providers • Complaints and Enquiries • Development of West Road (September 2024) • Supporting Multi-Agency Neurodevelopmental Implementation Groups (Pan- Ayrshire) • Introduction of Care Co-ordinator Roles • Development of 18+ Years Assessment Clinic • Waiting List Wellbeing Check-In • Neuro-Affirming Reports Templates • MDT Diagnostic Case Discussions • LD Diagnostic Clinics • Psychology Consult Appointments CEDS CEDS commissioned a Review of Community Eating Disorders in 2021-22 through Main Street Consulting to consider the improvements that would be anticipated in the National Review. A CEDS Stakeholder Event in January 2024 explored these and highlighted where they can help to bridge the gaps. From the event it was decided that the development of an Extreme Team would be paramount in service development. It was about this time that it became apparent that CEDS had no allocated budget and has been funded for years by the CAMHS underspend as far back as 2012. A Business case is being developed and an SBAR prepared for PSMT. The CEDS referral form was updated which contains information on the MEED Risk Assessment (formally Marsipan) and CEDS Referral Guidelines have been developed and approved at Clinical Governance. At present AN & BN (BED 2024). A Severe and Enduring Service (SEED) has been established and patients identified. In March/April 2025 CEDS moved from Kiln Walk to a newly renovated building which has much more clinic space and be appropriate to carry out groups and physical health checks. CEDS Participation Officer has been involved with patients who are interested in being involved in service redesign workshops. A QR code has been developed for patients who have been discharged from the service, resulting in valuable feedback – qualitative and quantitative. A MAUDSLEY model for carers is currently being developed by CEDS clinicians. The lack of dedicated Psychiatry for Adults is the most pressing clinical risk to the service. Quality Improvement & Data The Service has used Improvement methodology and tools to capture qualitative and quantitative data to inform service redesign and PDSA’s tests of change to small scale changes before larger scale redesign. DCAQ (Demand, Capacity & Queue) to ensure that the workforce capacity can meet demand and highlight areas where alternative solutions for gaps in workforce recruitment (Pharmacy Prescribers, Nurse Prescribers, Allied Health Professionals). Taking risks around new posts like the Quality Improvement Advisor, Participation and Data/Information Analysts posts. Redesign and improvement work in CAMHS and CEDS A&A that it is recognised nationally
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19th June 2023 – Spotlight Presentation at the NHS Scotland Event – Redesigning CAMHS in A&A 2020-2023 21st June 2022 – Winner of the Integrated Care Poster at the NHS Scotland Conference, Aberdeen for the CAMHS Leisure Project in Partnership with 3 Leisure Services across Ayrshire CAMHS Benson Wintere Data Model This PowerBI model was designed by CAMHS with the assistance of an external contractor as there was not the expertise with NHS A&A. This information is highly sought after by other boards and is of particular interest to Scottish Government who have seen the data. We are the only board that can see at a glance a dashboard of CAMHS data including the RTT and compliance and we know the numbers of referrals we are ‘meaningfully redirecting’. School cluster level of detail in the Benson Model
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We are able to look at the data and split it into North/South and East Ayrshire and we are then able to look at the secondary school and cluster primary schools in terms of reason for referral to the service. Inbuilt in the model is the school roll numbers to enable us to see the percentage referral rate for each school and the SIMD (Scottish Index of Multiple Deprivation) giving us information in terms of the referrals and the deprivation categories for all those referred in. This information has been shared with colleagues across Ayrshire in terms of Children’s Services and presented to elected members across Ayrshire. CAMHS Participation Officer The CAMHS Participation has been involved in so much of the redesign work within CAMHS ensuring that young people and family stories are heard. Much of the work is around engaging with key stakeholders which included care experienced young people and young carers. The Participation Officer has also done lots of collaborative working with NEST (Neurodevelopmental Empowerment & Strategy Team) and the Bairns Hoose work with Scottish Government.
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The Participation Officer has also been instrumental in testing the Mindlog app with young people in the service who use the app to do twice daily checkins that are then uploaded and sent to CAMHS clinical mailbox for discussion with the young person at their next appointment. Ready for Anything was a collaborative project with Adventure Carrick - an outdoor education centre specialising in water sports. Our aim was to develop a groupwork opportunity for young people (YP) to learn to manage their symptoms of anxiety. The role of the Participation Officer was instrumental in the successful running of this project. Other work the Participation Officer has been involved in is the Children In Scotland Engagement which is Engagement with patients around their experiences and what support has worked / hasn’t worked in the past. This would influence CIS updating Essential CAMHS training toolkit. Psychology Provision Psychology within CAMHS deliver NES packages re: Anxiety – delivery and also training to wider staff group – NHS and community. Group work is undertaken by CAAPS – early intervention and peer support. Psychology input to the CUAIT Team for delivery IPT-A C. There are a few challenges for psychology including; filling vacancies, need to expand provision to cover roles/responsibilities, overall increase in referrals to CAMHS and concerns regarding C&YP Mental Health – increase in both numbers and complexity and significant demands in relation to Neurodevelopmental concerns and assessment. Pharmacy Pharmacy have been instrumental in helping the medication clinics develop and really helped the service manage medication during the shortages of ADHD medication. They have contributed to the training and development of other staff and are a point of contact for medication advice from other members of the team. They also have a very important patient facing role and see many young people starting on medication.
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Psychiatry The role of Psychiatry has grown in the last 2 years from a position of virtually having no psychiatry. Psychiatry is involved with all aspects of CAMHS and CEDS. Most recently Psychiatry has been leading on the potential for an LD CAMHS Service in Ayrshire and Arran. Prevalence rate of mental health difficulties is 31- 41% for children and adolescents with learning disabilities - significantly higher than the general population The needs of young people with learning disabilities and mental health difficulties are not currently well served by existing services in many areas of the UK including Ayrshire, where there are disjointed services and gaps in provision. A Business Case is being discussed with CAMHS and the LD Service in Ayrshire and Arran. Admin is a critical part of the service and essential to the smooth running of the service. By centralising the management of CAMHS and CEDS this has really helped in SSTS, procurement, reduction in clinical mailboxes and a robust process for ensuring that all new staff are added to Trakcare. Admin have been integral in suggesting improvements in processes and ensuring that standardised letters and the text reminders go out timeously.
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The Admin Manager also sits on the Management and Leadership Team for CAMHS and CEDS and is integral to the decision making for process change. Sleep Pathway Development A specific sleep pathway has been developed in CAMHS to ensure that there is an initial appointment with the young person, family/carer to issue Sleep Diaries and explain height and weight and physical apt as well as using a screening tool. Previously, families requested melatonin straight away for sleep issues and sleep diaries were not returned. This allows a discussion about how and why sleep diaries need to be completed and when they are returned another appointment is scheduled and potential intervention for 4-6 sessions is agreed. This ensures that all sleep hygiene is carried out before medication is offered as per guidelines. New Accommodation for N-CAMHS and CEDS 2025
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The new facility at West Road for N-CAMHS (Neuro CAMHS) and CEDS (Community Eating Disorder Service) has resulted in an improved environment to carry out physical examinations and improved the wellbeing for patients and staff in the facility. Previously physical examinations were being carried out in environments which were must less suitable. The newly refurbished facility will enable a much safer and hygienic environment which the workforce have been involved in designing. West Road N-CAMHS (Neuro CAMHS) and CEDS (Community Eating Disorder Service) opened to staff March/April 2025 and first patients were seen 22nd April 2025. The Official Opening was on the 22nd of May 2025 with the Leader of the Council and the Provost carrying out these duties.
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Appendix 3 Health, Social Care and Sport Committee ADHD and ASD pathways and support The Health, Social Care and Sport Committee is undertaking an inquiry into Attention Deficit and Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) pathways and support. The inquiry seeks to: understand why waiting times for diagnosis and management of ADHD and ASD are reportedly long, including the drivers of increasing demand understand how these conditions are diagnosed and managed understand the impact of delays on individuals explore solutions to improve capacity of services, referral pathways and support. Question “Please tell us your views on the aims of the inquiry, in relation to the people you support, and describe any opportunities for improvement you have identified.” understand why waiting times for diagnosis and management of ADHD and ASD are reportedly long, including the drivers of increasing demand Understand how these conditions are diagnosed and managed. To understand why waiting times for diagnosis and management of ADHD and ASD are long and increasing you must look at both societal and structural/operational factors that have combined to form a perfect storm of increasing demand and decreasing capacity. Public awareness and understanding of ADHD and ASD have increased at a rate no one predicted or planned for. Across Scotland and the UK there is a significant increase in children, young people and adults seeking information, support, assessment and treatment for neurodevelopmental conditions (including ADHD and ASD). The lack of national accompanying investment in neurodevelopmental services has funnelled this increase in demand through Mental Health services that had no additional capacity to cope with even the smallest of increase in referrals. Our Neuro-CAMHS service received a small investment, however this was insufficient in comparison to the extra pressure on the service. Our adult services have had no additional funding. Many health boards and HSCP’s have traditionally supported neurodevelopmental assessment and treatment via their mental health pathways through services such as CAMHS and local CMHT’s. This has been a natural development due to professional expertise required being available in these services. Over the past 4-5 years, locally we have been overwhelmed when met with an estimated increase in demand of 20-30% for neurodevelopmental assessment and treatment. The consequence of which means the core business of these services to assess and treat people with acute mental health conditions has become increasingly difficult to deliver, presenting mental health services with an unexpected and continuing crisis and an unacceptable level of risk leading to difficult operational and clinical decisions. In addition to this increase in demand and the lack of specialist neurodevelopmental services, there is a national workforce shortage in many areas associated with the assessment and support of neurodivergent people. Difficulty in recruiting and retaining professionals in disciplines such as SLT, OT, Psychology and Psychiatry is a significant factor in the service delivery issues faced across Ayrshire. Our Community Paediatric services provide assessment and treatment for our pre-school children and children with cooccurring developmental and physical health conditions. They face the same demand/capacity and workforce challenges as CAMHS and CMHT’s. They are also working at maximum capacity with no additional resources. The circumstances detailed above have left two main scenarios across Ayrshire.
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During the early stages of this increase in demand, mental health services and community paediatrics continued to receive referrals for neurodevelopmental assessment with no additional national or local resource to strengthen teams or create separate specialist neurodevelopmental services. Consequently, the increase in waiting list numbers and waiting times has increased exponentially. This increase has not always been visible in reported RTT due to lack of reporting the ND demand within services or the national mandated requirement for this in RTT targets. In order to deliver and maintain their legislative requirements, CAMHS must work in line with the Scottish Government CAMHS Specification and can therefore only accept neurodevelopmental referrals as part of wider assessment of a cooccurring moderate to significant mental health condition. This action has meant a slowdown in the growth of waiting lists. However, this doesn’t address in any timely manner, the individuals who were already on a waiting list. This has also created a scenario where it is impossible to accurately track the demand for children and young people who do not meet the mental health referral criteria but require a Neurodevelopmental assessment and/or support. Similarly, within the adult CMHT’s, neurodevelopmental assessment is only available as part of a wider mental health assessment where criteria for the service is met. Due to all the reasons outlined above, there are no options for assessment and treatment for children, young people and adults in Ayrshire who have a suspected neurodevelopmental profile but do not meet criteria to access a mental health service. Our citizens who are seeking neurodevelopmental assessment and do not meet criteria for the existing mental health services are informed about our local Neurodevelopmental advice and guidance service. No diagnosis is needed to access this service and individuals can contact the service directly with no clinical or referral pathway. Despite some limited national work and significant local work to evaluate and address shortage in assessment and treatment, individuals and families can still feel lost and unsure as to where to turn without a diagnosis. Many individuals, families and professionals believe the absence of a neurodevelopmental diagnostic pathway as part of the wider support network, is unacceptable and national resource must be provided to assist local areas with meaningful resources to fulfil their duty in this area. This demand is particularly stark where impacting or limiting access to medication and treatment. Understand the impact of delays on individuals To understand the impact of these delays and lack of specialist neurodevelopmental services out with our mental health provision, the three Ayrshire HSCP’s have been engaging with local people in different ways over the past five years. This engagement has increased over the past two years with the introduction of local multi agency implementation teams tasked with scoping out opportunities to operationalise many of the National Neurodevelopmental Specification principals and standards (for children/young people and families). The development of our local Neurodevelopmental Empowerment & Strategy Team (NEST) has provided a vehicle through which each partnerships engagement team can reach our neurodivergent citizens and their families. The majority of engagement has been aimed at families and carers. We have also engaged specifically with adults who are diagnosed or suspected to have ADHD. Similar themes are evident throughout Ayrshire, across age groups and individuals and families. It must be noted that the continuous work carried out by the implementation teams, health, education and NEST to specifically address the needs of diagnosed or undiagnosed neurodivergent individuals and families was highlighted in a positive way through many of the stories and experiences shared in the latest round of engagement events. However, to address the question posed in the aims of this enquiry, there are themes that strongly link to the difficulties in accessing assessment or the long waiting periods people have if they are offered assessment.
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Themes such as isolation, desperation, family crisis, lack of opportunity, not being listened to, lack of validation, lost in the system, hopelessness and a real sense of frustration are evident throughout all engagement carried out. It is well evidenced and documented that statistically, individuals who have a neurodivergent profile and do not receive supportive intervention at an early stage have significantly lower chances of positive health and social economic outcomes. Higher rates of isolation, educational difficulties, challenges in the workplace, unemployment, relationship challenges, financial challenges, poor mental health, mental illness, addiction and suicide are consistently reported. The testimony of local citizens across all areas of Scotland and the published national and international data on life outcomes must be at the forefront of decisions relating to allocation of resource, strategic workforce planning and service redesign. explore solutions to improve capacity of services, referral pathways and support. Locally we are dedicating significant time looking at potential pathways of support and assessment. There is recognition that the assessment and support of neurodevelopmental conditions is very complex and often does not come alone as a single issue that is easily diagnosed and supported. Taking a holistic and trauma informed approach in ND assessments is going to be essential to ensure safe and helpful diagnostics and formulation of a person’s presentation. Individuals who present with potential neurodivergent profiles can have multiple associated health/mental health difficulties, as well as complex social and environmental backgrounds. Recognising the complexity of people’s lives is essential in the wider assessment/treatment and support pathways offered. When assessment and support pathways are being developed, they must be cognizant of the above and designed with the whole person in mind. Multiagency/disciplinary pathways are essential if the right support, at the right time is to be achieved. Community based support in Ayrshire is increasing with investment in our NHS service Neurodevelopmental Empowerment & Strategy Team (NEST) and the commissioned National Autistic Society service, Autism Support Ayrshire. Relationships between health, education, social work, third sector and our neurodivergent citizens is becoming stronger and better joined up, however there is still some way to go to establish truly integrated multidisciplinary pathways for assessment and support. Support regardless of a diagnosis and at the earliest opportunity has been increasingly the ethos and direction services are taking across Ayrshire. This principle is also at the heart of potential pathways being designed. Scottish Government and its local partners must recognise the importance of planning and investment in support services and diagnostic services equally. Our community supports such as NEST and Autism Support Ayrshire are having a demonstrable positive impact on our neurodivergent individuals and families. Both services are available at the point of need and no diagnosis is required to access these. These services are focused on advice, guidance, and empowerment. Through the NEST model, we are successfully creating one central space in Ayrshire where individuals, families and professionals can access advice, guidance and connections. Online and in person education, workshops and one to one advice and guidance are now available for all diagnosed or suspected neurodivergent citizens and their families across Ayrshire. NEST have also built essential partnerships with their partners in both Health and Education as well as the Third Sector and Peer Led supports. These supports have been designed in close partnership with neurodivergent people. The “Nothing about us without us” principle should be adopted when models of support are being designed and implemented. These services are in place and bringing positive change. However, they are under increasing pressure due to an increase of general awareness but also the demand for help
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created through the lack of an assessment pathway for the majority of our citizens. Demonstrating that support alone is not always going to be enough for people who require further clarification, validation and potential clinical treatment only made available through a formal diagnosis. However, despite the need for a diagnostic pathway to be available, these services are an essential part of the neurodevelopmental support structure in Ayrshire. These are not clinical services and demonstrate that non-clinical supports can work very well when co-designed with the people who use them. This also demonstrates that wider capacity and a more holistic offering can be achieved through the recruitment of individuals from a non-clinical background. Solving some of the forementioned difficulties within the system caused through a shortage in clinical workforce. Submitted 18th August 2025