Agenda item

For the Select Committee to receive a presentation from the Hampshire and Isle of Wight Partnership of Clinical Commissioning Groups on Autism Assessment Services for Children and Young People.

The Committee received a presentation from Matt Powell of the Hampshire and Isle of Wight Partnership of Clinical Commissioning Groups providing an update on Autism Assessment Services for Children and Young People (Item 7 in the Minute Book).  This followed a previous update to the Committee on 18 September 2019.

The presentation was introduced by highlighting key issues and challenges and the Committee heard that there were significant delays for autism assessments with an average waiting list of around 1,750 assessments with a waiting time of around 3 years.  Members noted that this was significantly outside of the current guidance of 13 weeks for an assessment from referral.  It was highlighted that piecemeal investment over the last two years had also poorly managed this waiting list. 

Members attention was drawn to page 2 of the presentation slides which explained the need for a cultural shift in schools from being diagnostic reliant to a focus on interventions such as sensory support and anxiety management.  It was heard that once interventions have been provided then a diagnosis can then be sought if necessary.  Page 3 of the presentation slides highlighted the other demands and the impact of Covid-19 which had disrupted commissioning plans, and commissioning remained at 2019/20 levels.  It was explained that there was a need to look at longer term procurement to future proof the Service.  It was also highlighted that there had been significant changes to senior leadership during November and December 2019 and the effect of this on procurement planning was explained.  Members heard that short term commissioning arrangements needed to be extended, and Covid lockdown had also affected the delivery of face to face autism assessments, and it was heard that the decision was taken to award the delivery of this to two providers who would be able to provide non face to face assessments for an initial 12 months.  Page 4 of the presentation slides also highlighted the progress that had been made by the Service in recent months which included a rapid deep dive and diagnostic to assess waiting lists, the agreement of additional funding in July 2020 for completion of 250 assessments in 2 months and the completion of an options paper on commissioning and budgets.

Page 5 of the presentation slides highlighted that ‘wicked’ refers to the situation in hand and how best to solve the crisis, and this was explained to the Committee in term of a multi-faceted phased approach.  It was heard that on the Isle of Wight, an 80% reduction was seen after these interventions had been put in place, and Members heard that there was confidence that this could work in Hampshire but would need to agree a funding regime for this.

Members heard that appropriate intervention as early as possible was the best solution and continuing to invest in assessment only service will promote families seeking diagnosis rather than support, with a risk of misdiagnosis for some children.  In concluding, Members attention was drawn to the services that the Commissioners recommended for development and implementation which included: Social and Emotional Mental Health Service, Therapeutic Intervention and ongoing work with schools and parents in changing culture and understanding around diagnosis. 

In response to questions, Members heard:

• That children on the waiting list, approaching 18 years of age, would be prioritised for autism assessment diagnostics, to ensure that they received this before adulthood.
• That work was underway to try and change the diagnostic culture.  It was heard that to reduce a reliance on diagnosis would be a huge undertaking, but would also reap huge benefits, and this needed to happen to reduce the waiting lists for assessments.
• That adjustments and techniques can also help and a shift was needed towards more preventative and intervention measures, with relevant support mechanisms in place.  It was explained that every child did have a right to a diagnosis, and in some cases in relation to housing requirements, this was needed.
• That in relation to rising Autism figures, a national party across England was looking at Autism, and the South of England was looking to frame an Autism pathway for all children.  Schools have also improved in identifying children who may need to be referred for a diagnosis, but it was important to ensure that interventions were put in place before a diagnosis to provide support, so a diagnosis could then be carried out at the appropriate time.
• That on the Isle of Wight, Occupational Therapists provided social, emotional and mental health training to colleagues in schools to better understand the needs of children.  It was explained that with better use of appropriate interventions, Officers were hopeful that a reduction in waiting lists of at least 50% could be achieved in Hampshire.
• That it was hoping to get through the waiting list backlog within two years, but this would be difficult given the competing demands for money within the financial framework, and Officers were seeking support from the Select Committee with this.
• That liaison with all partner agencies to look at modelling was taking place and waiting times was a significant issue nationally.

An additional recommendation was proposed by Councillor Kirsty North and seconded by Councillor Fran Carpenter:

‘That the Chairman of the Select Committee writes to the 5 Hampshire CCGs asking them to commission a preventative model of funding for Autism Assessments as has been tested on the Isle of Wight here in Hampshire’.

It was confirmed that co-opted members of the Committee were not eligible to vote on this recommendation.  A vote was held, and this recommendation was agreed by Members.

A further additional recommendation was proposed by Councillor Jackie Porter and seconded by Councillor Malcom Wade:

‘That the Select Committee receives a written report for every meeting until the Committee are satisfied that the service has caught up and is providing a timely service for children, parents and schools and proof that the service is making progress.’

Councillor Porter raised the importance of continuing to support the Service but also that the Committee needed the opportunity to also challenge and ask questions, as the issue of long waiting times for assessments had been ongoing.  Councillor Wade stressed that it was important to support the Service and to keep a strong focus on this and receive frequent updates.

Some Members were concerned about the frequency of receiving written reports for every meeting and the pressure this would put on Officers. 

It was confirmed that co-opted members of the Committee were not eligible to vote on this recommendation.  A vote was held, and this recommendation was agreed by a majority of Members.

RESOLVED:

That the Children and Young People Select Committee:

i)          Received and noted the update provided. 

ii)      That the Select Committee receives a written report for every meeting until the Committee are satisfied that the service has caught up and is providing a timely service for children, parents and schools and proof that the service is making progress.

iii)      That the Chairman of the Select Committee writes to the 5 Hampshire CCGs asking them to commission a preventative model of funding for Autism Assessments as has been tested on the Isle of Wight here in Hampshire.