Scrutiny taking the lead on child and adolescent mental health in Cornwall

Cornwall’s Scrutiny Commission’s review of child and adolescent mental health services shone a light on mental health, something which had been systematically overlooked as concerns of adult social care dominated discussions. The review was instrumental in ensuring the development of the subsequent Child and Adolescent Mental Health Strategy for Cornwall.

The challenge

Following local engagement with young people, issues regarding mental health services appeared to be continually raised as an area of concern; nationally, concerns were also raised by the Members of the Youth Parliament (UK). Repeated inspections had highlighted issues in relation to the provision of children’s mental health services in Cornwall since 2008, and there appeared to be a lack of demonstrable progress in improving outcomes for children and young people using these services.

The then portfolio holder presented these concerns to scrutiny councillors at an informal meeting in October 2013, asking them to undertake a review. The Committee was supportive of his concerns and agreed to review the matter.

The solution

The power of scrutiny lies in the influence that it can exert on the council and its partners. The Scrutiny Committee used the opportunity to run a select committee review involving many local stakeholders, including the council, health providers/commissioners, voluntary sector and patient representatives.

Select committee reviews can be both ‘hard’ and ‘soft’ in approach, but still powerful. Mental health is a difficult topic to discuss, as many people do not wish to talk about their own circumstances.  However the stories and examples of the pathways taken by young people were the pieces of evidence which resonated most with members. Mental health services go beyond statutory organisations, and councillors felt that there had to be a way listening more widely; not just during the review itself, but after.

Following the approval of the scope in December 2013, the Committee called for evidence and a number of organisations were identified to provide oral evidence at a series of public meetings in February 2014. In addition to the verbal evidence received, the Select Committee Panel received a large amount of written evidence from interested parties; all of which was considered in public.

The Panel met a number of times to deliberate and review its findings, in order to produce a view and recommendations. The review looked at the status of child and adolescent mental health services and the outcomes for young people, including:

  • examining if there were improving outcomes for those children and young people using services, and how these outcomes are monitored
  • examining this through robust and meaningful performance data and their processes
  • examining the difficulties raised by frontline staff in relation to advice, consultation and treatment
  • examining how gaps identified in the Mental Health Needs Assessment are being filled.

The review, and subsequent report highlighted areas of concern to the council and its partners, and made a series of recommendations for improvement.

The review enabled councillors to hear the problems and concerns being raised by young people and then provided the opportunity to question those involved in the commissioning and provision of services.

Councillors felt that they needed evidence from across the system, not just from the local mental health trust or the council. Therefore, many partners were asked if they wished to provide evidence as witnesses, either in person or in writing. Not all partners agreed with the findings of the review, but all did participate, respecting its publication and considering its recommendations.

This piece of work provided a focus on child and adolescent mental health services locally, both within and outside of Cornwall Council. It garnered much media attention bringing the mental health of young people firmly into the spotlight. The information gleaned and recommendations made were also fed into the National Review of Child and Adolescent Mental Health Services.

The impact

The Committee in its various iterations since 2014 has continued to shine a light on this area of provision and commissioning. The review was instrumental in ensuring the development of the subsequent Child and Adolescent Mental Health Strategy for Cornwall which took account of the review outcome, and the concerns raised by young people.

One of the findings and areas for improvement related to Tier 4 in-patient provision in Cornwall; in fact this was a specific recommendation. Councillors were very passionate that young people should not be travelling or living hundreds of miles away, when receiving treatment or assessment. They maintained pressure on the commissioners and providers through their scrutiny role to ensure the matters received attention.

This formal pressure and awareness was complementary to a huge amount of work and campaigning undertaken by a local charity, set up as a result of the loss of the founders’ son.

Following the recommendations being accepted by agencies, the report was submitted to the Parliamentary Health Select Committee as evidence for their national review of child and adolescent mental health.

In 2016, NHS England announced that Cornwall would receive funding for the building of a new in-patient CAMHS unit.

Demonstrating local leadership and accountability

Scrutiny is part of the local accountability and democratic framework that works to support better outcomes for local people. This work allowed a number of councillors to be involved in highlighting local concerns and seeing this through to recommendations and implementation.

Councillors still actively review the strategy, provision and commissioning of child and adolescent mental health services locally. They require reports to be brought to formal Overview and Scrutiny Committee meetings frequently, regarding both the development of action plans, and the outcomes and concerns of young people currently using services. There has also been a number of national campaigns relating to mental health services which councillors have promoted.

The influential role that this review had will be felt for many years.


Leanne Martin
Democratic and Governance Officer, Cornwall Council

This case study, written by Su Turner of Insight to Impact Consulting Ltd, is taken from the forthcoming LGA publication ‘Lessons in local leadership and accountability for children’s mental health services’.

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