Alder Hey Children's NHS Foundation Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last inspection we rated this key question as good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The service assessed people’s needs and ensured that those needs were met. The service provided care, treatment and interventions suitable to the needs of children and young people and in line with national guidance about best practice. Staff supported people to live healthier lives.

The service made use of outcome measures to monitor patients’ progress and inform clinical decisions. Teams had good relationships with other services, both within the Trust and within the voluntary and community sector.

Staff assessed peoples’ capacity to consent to treatment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff completed a comprehensive assessment of each child or young person’s mental health and personal needs. We reviewed 28 care and treatment records during our inspection and found that each record had an assessment of need in place. Assessments were multi-disciplinary and included input from different professionals. Specialist assessments were in place where required, for example the ADHD service utilised the SNAP-IV rating scale for children and young people which was completed by a parent, teacher or carer as part of their assessment process.

Assessment and the gathering of relevant information began at the referral and triage stage of care pathways. The ADHD service had introduced an Achenbach triage within the triage process as part of the ADHD improvement project. The Achenbach triage helped the service identify children, young people, families, carers and schools that were not engaging in the assessment process and who may require additional support.

Children, young people, parents and carers we spoke with during our inspection told us they felt involved in their assessment process. They told us that they had worked with staff to develop their goals and objectives and had a say in agreed treatment options. Assessments and needs were reviewed at each appointment.

Staff developed care plans that met the needs identified in assessments. Care plans were personalised, holistic and recovery orientated. Children, young people, family members and carers we spoke with during the inspection told us they felt involved in the care planning process and had an understanding of what their care plan was and the information it contained. Care plans were shared with children, young people, family members and carers in letter form. They were reviewed and updated regularly at appointments.

Staff provided a range of treatment and care for service users based on national guidance and best practice. The teams within the service included or had access to a range of disciplines and specialists required to deliver those interventions and to meet the needs of service users, families and carers in the service.

The service offered interventions recommended by the National Institute for Health Care Excellence (NICE) and delivered them in line with their guidance. These included prescribing medication as well as a range of psychological therapies including compassion focussed therapy (CFT), family and systemic psychotherapy (FT), dialectical behaviour therapy (DBT) and cognitive behaviour therapy (CBT). In addition, the service offered social prescribing including Forest School, which is a learning approach that takes place outdoors in nature and seeks to develop personal, social and technical skills, fishing groups and the Dreamers Project which offered bespoke one-to-one creative activities to service users to complement their clinical treatment. There was a menu of treatment options available to service users, families and carers.

There was a policy and process in place to support the identification and dissemination of best practice and new guidance developed by the NICE as well as relevant national programmes and enquiries. Senior clinical staff within the service had been part of teams developing national guidance. For example, the Clinical Lead for crisis care had been involved in the creation of NHS England’s Children and Young People National Crisis Service Guidance (2024). Staff were also encouraged and supported to develop new evidence-based interventions to support service users and families. For example, a Peer Support Worker had introduced a Lads Mental Health support group based on the structure and five question methodology of the national Andy’s Man Club initiative.

The service had a rolling programme of clinical audit to ensure that care, medication and clinical interventions were being delivered in line with national guidance and the service and Trust’s policies. There were standard audits repeated at a regular basis supported by bespoke audits identified through processes such as service user feedback and incident reviews. Audits covered areas such as prescribing, risk assessments, transitions and care planning.

Staff made sure children and young people had support for their physical health needs, either from their GP, community services or specialist practitioners. They supported children and young people to live healthier lives by supporting them to take part in health and healthier living programmes, by providing advice and information and where appropriate referring them to specialist services.

Staff held regular and effective multidisciplinary meetings. Within the main CAMHS teams each multidisciplinary team held a weekly multidisciplinary team meeting. We observed 2 multidisciplinary meetings during our inspection. Meetings were attended by a full range of professionals. They were well structured and provided a space to review service users care and treatment. Meetings were well structured and demonstrated effective information sharing, risk management and care planning.

Teams had effective working relationships, including good handovers, with other relevant teams within the Trust. The crisis service worked closely with the hospital’s Emergency Department to help manage children or young people who presented with a mental health concern. The service, along with the Mental Health Liaison team worked with acute wards within the hospital when a child or young person with mental health concerns was admitted for a physical health issue. We held a focus group with staff from the Emergency Department and acute wards during our inspection. Staff told us that whilst there were still some challenges the relationship and working practices between the acute and mental health services had improved in the last 4 years and that a lot of work had been undertaken to achieve this. There was a monthly meeting between the crisis service, Emergency Department and acute wards to continue this work, manage the clinical pathway and ensure that appropriate support was provided to children, young people and staff on acute wards were service users with co-morbid mental health issues.

ADHD and ASD services worked closely with CAMHS services to coordinate care and support children and young people who were under both services or had an ADHD or ASD diagnosis.

The teams had effective working relationships with services and organisations outside of the Trust. Services worked closely with GPs, schools and third sector organisations to provide joined up treatment and care pathways. There were clear referral processes for external professionals and organisations to refer into the CAMHS service and for the CAMHS service to refer service users to them. The service was linked in with a range of third sector and volunteer support agencies which ensured service users had an effective menu of treatment options both during treatment and following discharge.

Teams were part of wider multi-agency initiatives and collaborative approaches. For example, we spoke with the Enhanced Support Team in the Sefton CAMHS service who were part of the North Mersey Vanguard. The North Mersey Vanguard was a collaborative team who worked with the local authority’s protection against child exploitation team, youth offender teams, voluntary organisations and other relevant stakeholders to provide a joined up approach to vulnerable children and young people who required assertive outreach and enhanced support. In addition, the service was part of local Multi-Agency Safeguarding Hubs, and the Mental Health Support Teams were part of cluster meetings led by the local authorities.

Staff supported patients to live healthier lives. Care plans and service user records we reviewed included consideration of physical health, lifestyle and wellbeing needs. Staff provided healthy living advice and information to service users and supported them to take part in health and healthier living programmes. There were referral pathways into specialist services and access to specialist practitioners such as dietitians, and speech and language therapists.

Service users had access to social prescribing schemes to improve wellbeing and promote physical activity.

The service had links with local Primary Care Networks and worked with GPs to ensure that service users had annual health reviews. The service also provided specialist training and education to GPs.

Staff used recognised rating scales to assess and record severity. These included self-report scales completed by both children and young people as well as parents and carers. For example, children and young people routinely completed ‘how are things’ self-report scales. There were scales for a range of conditions including anxiety, social anxiety, depression, panic and separation anxiety. There were corresponding self-report scales for each condition that were completed by parents or carers to give a full picture. Staff worked with children and young people to help them complete scales that informed care plans and treatment options. These included strengths and difficulties questionnaires and a goal progress chart.

Staff had access to a range of specialist outcomes measures to support delivery of care and monitor progress. These included the Beck’s depression inventory, the revised child anxiety and depression scale, the brief parental efficiency scale and the difficulties in emotion regulation scale. Children and young people completed session rating scales after sessions with staff, to help the service monitor quality and effectiveness of the session and the intervention being undertaken.

Staff collated outcome measures to monitor the progress of children and young people and assess the effectiveness of treatment. They produced regular reports detailing progress and outcomes that fed into discussions around care, treatment and care planning.

Staff took all practical steps to enable children and young people to make their own decisions. They gave them all possible support to make specific decisions for themselves. Staff we spoke with were knowledgeable about the Mental Capacity Act and the 5 guiding principles. They understood how to support children under 16 wishing to make their own decisions and applied the Gillick competency principles when necessary. In appointments that we observed we saw staff worked to ensure that children under the age of 16 understood the information that was provided to them and were in a position to make informed decisions.

The Trust had a Service Level Agreement in place with a local mental health trust to provide Mental Health Act and Mental Capacity Act management services. Although this related predominately to Tier 4 inpatient services it also covered some community activity including Community Treatment Orders (CTOs).

Service user capacity was recorded on the electronic care records system. However, it was not always clear how that capacity had been assessed. We did not see examples of best interest decisions within the notes we reviewed, however staff we spoke with were able to explain the best interest process and how they would follow it if required. However, staff did tell us that there was not a standard way of recording this on the records system.