Luke Wilden

Dear Madam, Re: Luke Wilden Regulation 28 Response This is a formal response to your Regulation 28 report dated 16 January 2022 relating to issues arising during the inquest into the death of Luke Wilden which concluded on 20 July 2021. Your concerns are as follows: “Transition arrangements within ELFT for individuals with high functioning autism were inadequate when Luke turned 18 and, as a result, he was not transferred to the appropriate adult mental health team for continued treatment and to enable provision of an appropriate adult social care package, including suitable accommodation for him. Whilst I understand that changes have been made within ELFT in order to address this gap in services, I am concerned that these may still not be sufficient. Furthermore, I am concerned that this gap in services may also exist on a national level.” I wish to assure you and the family of Mr Wilden that East London NHS Foundation (the Trust) takes these issues very seriously. I outline the steps that have been taken to address your concerns, within the Trust below. Reinforcing transition protocols I understand that you heard oral evidence at the inquest into Mr Wilden’s death that the Trust’s Bedford and Luton Directorate have already taken measures to reinforce its transition policy and protocols. In particular, the serious incident report into Mr Wilden’s death and the Trust’s transition policy and protocols were reviewed with relevant staff members at the CAMHS away day on 16 September 2020. Additionally, since 31 December 2020, the administrator within each CAMHS team, pulls a list of all existing service users on a monthly basis. Those age 17.5 (6 months from their

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18th birthday) are identified and discussed at the relevant CAMHS teams’ multidisciplinary meeting so that appropriate planning and transitioning to the correct adult services may be commenced.

CAMHS supervisors were also reminded of the importance of the transition policy and protocols and their monthly clinical supervision with staff members now includes performance monitoring of the transition policy and protocols.

An audit was also undertaken. A sample of 5 patients were reviewed over a period of 3 months to assess services’ compliance with the protocols. All cases reviewed met the required targets.

Since the inquest into Mr Wilden’s death, further work to reinforce transition protocols has been undertaken. Audits take place on a quarterly basis to review service user’s transition from children to adult services. The audits aim to identify and share good practice, ensure the young person and their family carers voice is central to support provided, identify areas for improvement and share the learning from this. More recently, both CAMHS and adult services have committed to undertaking joint audits to promote cross team learning and ensure improvements to the young person’s experience remains central to practice.

Additionally, Bedford and Luton’s Transition Policy has come up for review. A decision has been made that the policy be revamped to include the latest transition protocols with both CAMHS and Adult Mental Health services feeding into the final document. It is anticipated that this will be complete on 14 April 2022. The new policy will be reviewed at the first CAMHS away day following completion and reinforced through supervisors via monthly supervision.

Additional capacity for supporting transitions

To assist staff in reinforcing the transition policies and protocols outlined above, the Trust has also increased its capacity for supporting transitions from CAMHS to adult mental health and social care services. I understand that at the inquest you received submissions outlining various changes that the Trust had already undertaken specifically in relation to transition arrangements for individuals with high-functioning autism.

Since 1 March 2020, a full-time transition worker has been based in the Neuro Developmental Team dedicated to supporting the transitions of young people with autistic spectrum disorders including high-functioning autism. The transition worker works with patients from identification (6 months before their 18th birthday), through the transition and after their birthday to support and embed the transition. This includes supporting the young person, their family, partner agencies and the relevant adult service to smooth the transition as far as possible. They work with both referring and receiving local authority where relevant to ensure progress in transition planning. Particularly where the patient is be referred into a non-specialist neurodevelopmental team, the transition worker will also provide advice on engagement and support of that young person. Since the inquest, a 2nd transition worker has joined the Neurodevelopmental Team.

As of February 2022, two additional transition support workers have been hired to work across CAMHS to support service users on transition pathways from 6 months prior to their 18th birthday until they are embedded within adult mental health and social services.

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The Trust has just appointed a Strategic Transitions Lead. This role will provide system leadership across all agencies, including ensuring that robust transitions systems between children’s (CAMHS) and Adult Mental Health Care are maintained. They will also work with the relevant local authorities to ensure that robust transition pathways are in place across mental health services. They will ensure that the experience of the young person is at the heart of how of the systems and processes develop and operate.

Working with Local Authorities

Since the inquest, it has become clear that the Trust’s transition protocols and policies across both mental health services and adult social care would benefit from more cohesive working with the relevant local authority’s children’s services.

There is currently a safeguarding adults review (SAR) taking place in relation to Mr Wilden’s case. Bedford Borough Council safeguarding has requested a specific joint multi- agency, task and finish group (Task Group) to identify gaps in transitions across local authority and health. The findings will be fed back to the safeguarding board. The Trust is taking an active role in the SAR and the Task Group. Any significant findings will be fed into Trust Policy.

As part of the newly appointed Strategic Transitions Lead’s role, ELFT will propose a strategic multi-agency forum be established with all key partners, particularly its local authority partners, to ensure that transitions retains a system wide focus and that leadership can be provided on a collaborative basis, to the many teams and services that have the potential to interface with a young person and their family carers during their journey to adulthood.

We will outline this proposal to the Bedford Borough Council, Central Bedfordshire Borough Council and Luton Borough Council by 31 March. ELFT proposes to go ahead with this work regardless of local authority participation – but notes it will not be as affective without our key partners engagement.

To conclude, I hope this reassures you and Mr Wilden’s family that the Trust has undertaken a full review of the concerns and addressed them robustly. The Trust remains open to continuing dialogue with Mr Wilden’s family if they would find it helpful in order to answer questions, clarify action or address additional concerns.

I also look forward to reviewing NHS England’s response and any further national guidance that may result.