Agenda item

This briefing from ICB colleagues seeks input and views from Committee members about Adult Autism and ADHD Assessment services, and in particular: service pressures and risks; the pilot phase including service developments and engagement events; the proposed solutions which reflect the learning from the pilot phase; and what happens next, including the work being undertaken by the Humber and North Yorkshire Mental Health, Learning Disabilities and Autism Collaborative.

Report to follow.

Members considered a report from the Humber and North Yorkshire Integrated Care Board (ICB) on assessment services for Adult Autism and ADHD (attention deficit hyperactivity disorder).

The Director of Nursing for York and North Yorkshire at the ICB, the ICB’s Assistant Director of Primary Care and Pathways for York, and the Head of Neurodevelopmental Services at The Retreat provided an overview, noting that:

·        There had been an exponential national rise in people being referred for assessment for ADHD and Autism. There had been an unprecedented increase in demand for local assessment services, which were commissioned from The Retreat.

·        In response to growing waiting list pressures, a pilot project had been introduced to test a new referral process as part of a needs-led service, including clear prioritisation criteria and an online screening and support tool.

·        The process had been subject to critical feedback, including from those with lived experience, and Healthwatch York.

·        Engagement with professionals and people with lived experience through the pilot phase had informed proposed solutions, including prioritisation being based on clinical professional judgment by GPs and Community Mental Health teams, improvements to the online platform, and work with the local provider to maximise availability of triage and assessment capacity.

In response to questions from the committee, it was confirmed that:

·        The service could now be accessed by telephone or email, as well as through the online platform, while there continued to be a direct referral route to The Retreat as the service provider; staff could help with filling in referral forms if needed.

·        Proposed changes to the online platform would see it used for purely for registering and confirmation referrals, not screening, and to provide some pre-diagnostic support while people were waiting. Digital platforms would only improve with feedback from service users, and members of the neurodiverse community would be involved in testing these changes over the next few months.

·        More work was needed with GPs and Community Mental Health teams to ensure that expectations were managed and that both professionals and people using the service understood the pathway.

·        There were challenges around recruitment, particularly for clinical psychologists, and at times sessional or locum staff were needed, although figures were not currently available for comparison with other ICBs or providers.

·        Demand was a significant and ongoing challenge. Although autism assessment times had improved through the pilot and capacity had increased, positive diagnoses had also risen, and around half of service capacity was now taken up by ADHD medication follow-ups. Figure 1 in the report referred to direct referrals to The Retreat and did not capture referrals from the platform. When the service was commissioned, 60 referrals per month had been expected; at peak times this had been as high as 400 per month although 80-100 per month was more typical, with a corresponding impact on resources.

·        Future work in conjunction with partners would focus on outreach to employers and education providers to develop more consistent pre-diagnostic support. Both of York’s universities were using the online platform and helping students with suitable academic adjustments and support plans.

·        There was an access gap for some groups including people who were homeless, living in hostels, or in prison. There was an ambition for a community-led service, but much work was needed to improve access for harder-to-reach groups, although the ICB did not commission prison services.

·        In making decisions on next steps, all options that could improve the service would be considered, including the possibility of re-procurement of the online platform. Colleagues in the neurodiverse community were valued critical friends in the design of online tools.

Resolved: To request that Members’ input in relation to the digitally excluded, managing expectations of the pathway, pre-diagnostic support, assessment times, and support at universities and for harder-to-reach groups be considered.

Reason:     To inform the proposed solutions under consideration for the commissioned service and the approach taken to involve patients and their representatives on changes to services.

[The meeting adjourned from 18:30-18:37 for a comfort break].