Concerns about lack of clarity and shared responsibility for mental health services

30th November 2021

Yesterday, 29 November, the Public Accounts Committee (PAC) held a public hearing with the Director General (DG) of Children, Young People, Education and Skills (CYPES), Mark Rogers, and the Director General of Health and Community Services (HCS), Caroline Landon, to explore how the departments work together and whether this leads to improvements to the services for the public and effective use of taxpayers' money. The hearing was part of an ongoing performance management review.

HCS and CYPES joint department responsibilities:

The two departments share responsibility for Child and Adult Mental Health Services (CAMHS) and the Child Development and Therapy Centre. The PAC found:

  • HCS and CYPES do not share commissioning of some clinical services, and the PAC welcomed their acknowledgement that they should.
  • There were few, if any, updated formal agreements (Memoranda of Understanding) for the delivery of shared service delivery, however there are shared practice models. The PAC believes that the agreements rely too heavily on the good working relationship of the current Director Generals.
  • An overall lack of clarity over responsibility for delivering these services. The PAC understands that collaboration is beneficial, however, stressed that accountability for specific aspects of key public services is vital.

Performance management of HCS and CYPES:

  • The PAC is aware of significant concerns from the public about the service delivery of some mental health services, whereby some patients are waiting 12 - 18 months for appointments.
  • The DG of HCS reported that it will take five years to get a HCS governance structure in place to deliver the care they want to deliver.
  • The DG of CYPES stated that the department is 'working as fast as they can with the investment the Government have put into this service' and the DG of HCS agreed that they should engage more with customer feedback.' The PAC welcomed the acknowledgement that improvements should be made to incorporate customer feedback to improve patient services.

Chair of the Public Accounts Committee, Deputy Inna Gardiner, commented: "The Public Accounts Committee welcomes the commitment of the two Director Generals to improve services. It shares the aspirations of the outgoing Director General of Children, Young People, Skills and Education Department's that CAMHS should be a leading service in context of other jurisdictions. However, we have concerns about whether all the changes and shared responsibilities between the two departments actually lead to better outcomes for the vulnerable groups they serve, especially children and young people's mental health services.

"We want to see efficient streamlined services with clear lines of responsibility, supporting those most in need and we are concerned there is an overload of bureaucracy and new silos forming which hinder this. We are looking forward to a strategy which encompasses all of the health and community services and allows them to work as a cohesive whole. We embrace the One Gov philosophy of collaborative working between departments but there must always be clear accountability and responsibility for when things go wrong and improvements to be made. We are also keen to see more customer feedback being used to improve the services."

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