*Independent investigation into the care and treatment of Patient I: November 2013

1. Risk Assessment
This recommendation is for the Local Authority and Youth Offending
When a risk assessment tool is to
Team
be used, there should be clear
guidance as to when a more
detailed risk assessment is
triggered. This should include when
and how such information is shared
between various agencies.

2. Data Sharing Policy and Procedure
NTW invested significant resources in the initial work relating to becoming a
It would be of great assistance if all
pilot site for ‘Contact Point’: a shared multi agency data system prior to its
agencies involved with a young
National implementation. Unfortunately due to a change in government
person such as patient I had access
policy this initiative was cancelled at National level.
to all relevant records via an
electronic system. This would
All Trust services, including Children and Young Peoples’ Services (CYPS), Completed
present a more rounded picture of
use an electronic health record system called RiO to input and store
Patient I Independent Investigation Action Plan – Published - Version 4 – 14 January 2014 1
the particular individual to the information about patients. The Trust and its Local Authority partners
professional involved. Further this recognise the value of sharing records via electronic systems and have
would allow a more thorough risk undertaken work to facilitate this.
assessment which, in turn, would
make the identification of any The current position is that in Northumberland and Newcastle there is an
appropriate services more overnight exchange of key clinical information between the Trust’s
straightforward. Effective electronic health record system and two Local Authority systems. In other
interagency working is fundamental localities there are reciprocal arrangements in place to have ‘read only’
to the delivery of good mental health access to electronic records. These processes support effective verbal and
care and mental health promotion written communication between professionals but are not seen as a
and could be supported by more substitute.
effective data sharing.
Difficulty sharing information led to the government commissioning a
second review of information governance by Dame Fiona Caldicott . The
review reinforced the six original Caldicott principles and made one addition
which should help with sharing information in future.
Information Sharing
The added principle is:
“The duty to share information can be as important as the duty to protect
patient confidentiality”. The Review highlights that for health professionals to
act in a patient’s best interest, they need to have all the available
information about the patient to do so. However, it is acknowledged that
current information governance provisions (or at least the interpretation of
them) have led to information not being shared when it should be.
Accordingly, Recommendation 2 of the Review specifically states that:
“for the purposes of direct care, relevant personal confidential data should
be shared among the registered and regulated health and social care
professionals who have a legitimate relationship with the individual.”
The advent of the Common Assessment Framework has provided a
Patient I Independent Investigation Action Plan – Published - Version 4 – 14 January 2014 2
framework to support multiagency working utilising the Team Around the
Child/family approach. This supports robust multiagency working and the
sharing of information. NTW CYPS staff participate fully in this process.

3. Health Care Treatment of
Patient I as a Child The Trust, as does the Panel, recognise that requirement at both a National
and local level have developed since Patient I was offered treatment as a
Where treatment is being offered to
child.
a child such as was offered to
patient I, such treatment should be
The young person was seen and assessed in Child and Adolescent Mental
evidenced based and should comply
Health Services (CAMHS) and given a diagnosis of ADHD. He was
with the appropriate NICE
prescribed medication in accordance with prescribing procedures and NICE
guidelines. In addition there should
guidance and the ongoing care and treatment was monitored by a
be a clear written care plan in
community paediatrician as was common practice at the time. This young
relation to that treatment.
person was also offered other forms of interventions to address behavioural
issues such as support from a nursery nurse.
As mentioned under recommendation 2 above, The advent of the Common Completed
Assessment Framework has provided a framework to support multiagency
working utilising the Team Around the Child/family approach. This supports
robust multiagency working and the sharing of information and would be
reflected in an associated care plan.
Since its formation in 2006, the Trust has had clear policy statements
regarding all young people having a care plan which should be cognisant of
and build on any Team Around The Child care plan in place. The current
policy NTW(C)48 is compliant with Department of Health guidance.
Refocusing CPA (2008) sets out that for young people who do not have
complex needs such that they meet the criteria for CPA, the care plan can
be recorded as a clinical letter, meeting the following standards:
o Should be written using language / terms that the young person /
parents / carers (if appropriate) are able to understand as much as it is
practicable.
Patient I Independent Investigation Action Plan – Published - Version 4 – 14 January 2014 3
o The care plan should clearly contain:
o The date of contact / clinic / visit;
o The current plan of intervention / care / treatment agreed with the
young person / and their parent/carer (if appropriate) and who is
providing this, the goals of the intervention including those
determined by the young person;
o Indicate the circumstances in which the young person may need
extra help and the associated crisis arrangements;
o The outcome of the assessment of risk.

4. Formal Assessment of a Child Moving Through Special Needs Provision This recommendation is for the Local Authority.
Assessment of cognitive ability due to concerns expressed regarding the
Patient I was never subject of a patient’s educational attainment would have been the responsibility of the
psychological assessment of his Educational Psychology Department and not the Trust at that time.
cognitive ability even though the
issue of a potential learning Since then, the NTW Children and Young Peoples Service has remodelled Completed
disability was raised on a number of and has prioritised integration of its young peoples community services to
occasions. It is recommended that it bring together what was previously CAMH and LD to improve assessment
would be appropriate for there to be and recognition of mental health and learning issues within the interagency
a formal assessment of any learning framework.
issues of a child moving through
special needs provision to ascertain
whether he or she has a learning
disability or difficulty to aid with the
identification of appropriate services.

5. Core Group/Team Around the Policy and Procedure
Child At the time that this young man was in high school, the school was a leader
in the city in developing a multiagency forum for partners to meet to discuss
It is clear that school attempts were children and young people of concern in order to plan a coordinated
made to involve all relevant approach to their management and support.
agencies in discussions on a regular
basis about the various presenting In recent years this has been replaced by the Team Around the Child Completed
problems which patient I exhibited. Approach as part of the Common Assessment Framework, as outlined
A system which involves health, above in recommendation 2 and 3.
YOT, education, police, social care
is clearly of benefit. A more rigorous
and regularised protocol for carrying
this into effect needs to be agreed
and appropriately resourced. It is
clear that such a system has
particular application in larger
schools whose catchment area
includes pupils with higher than
average levels of YOT involvement
and social problems.

6. Transitional Planning Policy and Procedure
The Trust recognises the risks from a lack of standardisation across
It is recommended that the transition agencies in relation to age however this recommendation stands outwith
from child to adult healthcare should current National policy guidance that recommends children and young
be set at the statutory school leaving people’s services should be provided to those up to the age of 18 years.
age. School leaving age was 16. It
is due to become age 17 in 2013 but The Trust is compliant with regard to National Service Framework Standard Completed
will be at age 18 from 2015 9 and the Newcastle Children’s Trust Board arrangements also adopt age
onwards. Transition has been a 18 years as being the threshold for transition to adult services. An increase
longstanding issue and it would in the school leaving age will further support this arrangement.
make practical common sense for all
agencies to work to one age. There The Trust CPA policy states an age of 18 years for transition and has
are examples of best practice within developed a Practice Guidance Note specifically with regard to managing
the region. One example given to the issues arising from the transition from children to adult mental health
the panel was for services relating to services.
children with disabilities and how the
Patient I Independent Investigation Action Plan – Published - Version 4 – 14 January 2014 5
transition from childhood to
adulthood was managed within that
sphere. Clearly a formula which
brings together services to assess
an individual’s ongoing needs and to
identify any services required as that
person moves into adulthood.

7. Adult ADHD Service This recommendation is for Commissioners.
Despite discussions being instigated
There remains no service currently for young people aged 18 years and
in 2008 about an adult ADHD
over who have an existing diagnosis of ADHD. The pilot service in
service, the service remains an
Newcastle is for new cases only where no diagnosis exists.
interim one and a final
commissioning decision is yet to be
Trust Specialist Service Managers submitted a comprehensive business
taken. It is clear the demand for the
case to commissioners regarding the risks arising from this group of patients
service is significant. The panel
and the amount of funding required to provide an appropriate service in the
recommends that such a service is
summer of 2013. This is currently under consideration however changes in
commissioned. In any event, a
commissioning arrangements have delayed decisions on this case.
decision on whether or not the
service is commissioned should be
In the meantime those accessing CYPS who reach 18 years are being
taken as a matter of urgency. Any
retained in the CYPS service under a duty of care arrangement as GPs are
service which is commissioned
unwilling to take on the prescribing and monitoring of medication without
should comply with NICE guidelines.
mental health service support. This is having a significant impact on this
This should include the creation of a
group of young people many of whom have other co morbid mental health
clear prescribing protocol with
issues that are untreated as well as the impact on CYPS who are treating
application across the region. The
young people that should not be in their service. This is causing pressures
absence of a clear commissioning
on waiting times and diverts resources from formally agreed and contracted
decision runs the risk that the
activity.
service which patients receive will
not meet their overall needs as
envisaged by the care programme
approach.
Patient I Independent Investigation Action Plan – Published - Version 4 – 14 January 2014 6