Robyn Skilton
PFD Report
All Responded
Ref: 2022-0247
All 1 response received
· Deadline: 25 Nov 2022
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Responses
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56-Day Deadline
25 Nov 2022
All responses received
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Source: Courts and Tribunals Judiciary
Coroner’s Concerns
Robyn was failed by the Mental Health Services quite frankly due to the current lack of resourcing and provision in place to support young people struggling with their mental health. Due to the lack of availability of a Child Psychiatrist there are long waiting times for children to be assessed. Robyn was not seen by a Child Psychiatrist and/or Psychologist, despite there being a need for this to happen, thereby enabling her to be diagnosed and receive a treatment plan. Robyn’s parents did everything they could during this period to support Robyn, including paying for a private counsellor, but sadly Robyn’s mental health continued to deteriorate during this time, and she took her own life. Robyn initial acceptance into tier 3 Children and Mental Health Services (CAMHS) similarly did not happen in a timely manner. I do appreciate that the landscape that the local mental health Trust (Sussex Partnership Foundation Trust) was working under and the fact that Covid heightened the level of complexity across many services but there were many failings in the care provided to Robyn. It became very clear during the Inquest that there is significant under funding of the local mental health Trust who like many mental health Trusts have seen an explosion of referrals to their Children and Mental Health services (CAMHS). By way of an example:- Referrals to West Sussex CAMHS have increased by 95.6% from May 2019 (389) to May 2022 (761) West Sussex CAMHS caseload has increased by 85% from May 2019 (2239) to May 2022 (4147) West Sussex CAMHS Duty caseload has increased by 112% from May 2021 (492) to May 2022 (1494) Mental Health A&E presentations, in period April 2021 - March 2022, have increased by 40% on previous year (April 2020 - March 2021). Additionally, across Sussex CAMHS, as a whole, the referrals data shows:-
• May 2022 was the highest number of referrals the service has ever received (1350).
• Of those 1350 referrals, 80% (1,081) were accepted into the service.
• In comparison, in May 2019, 579 were accepted (65% accepted)
• So, an additional 502 young people have been accepted in May 2022 compared to May 2019 Despite the increase in numbers accessing CAMHS there has not been any relative increase in resources to meet this demand and therefore the current position is is unsustainable and it is putting many young people’s lives at risk.
• May 2022 was the highest number of referrals the service has ever received (1350).
• Of those 1350 referrals, 80% (1,081) were accepted into the service.
• In comparison, in May 2019, 579 were accepted (65% accepted)
• So, an additional 502 young people have been accepted in May 2022 compared to May 2019 Despite the increase in numbers accessing CAMHS there has not been any relative increase in resources to meet this demand and therefore the current position is is unsustainable and it is putting many young people’s lives at risk.
Responses
The Department outlines ongoing national efforts, including the NHS Long Term Plan's commitment to increased mental health funding by 2023/24 to expand services for young people. It notes completed consultations on new waiting time standards, with next steps being worked on, and the analysis of responses from a public call for evidence.
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Dear Ms Schofield,
Thank you for your letter of 7 August 2022, to the Secretary of State Steve Barclay, about the death of Robyn Skilton. I am replying as Minister with responsibility for Mental Health, and I thank you for the additional time allowed.
Firstly, I would like to say how deeply saddened I was to read of the circumstances of Ms Skilton’s death. I can only begin to imagine how distressing her death will be for her parents and those who knew and loved her. I offer my heartfelt condolences.
It is vital that we take the learnings from what happened to Miss Skilton to prevent future deaths, and I am grateful to you for bringing these matters to my attention.
I appreciate your concerns about access to child and adolescent mental health services (CAMHS) in West Sussex, and I would like to assure you that we are working nationally to support local areas to expand mental health services so that more people can access the care and support they need.
The NHS Long Term Plan1, which we published in 2019, commits to increasing funding for, and access to, mental health services, with at least an additional £2.3billion a year being invested into these services by 2023/24. This increased investment will allow an additional 345,000 children and young people access to mental health services by then.
A significant portion of this funding is provided through baseline funding to local commissioners (formerly clinical commissioning groups and now through the integrated care boards that replaced them). This is supporting them to deliver on their responsibilities to commission healthcare services that meet the needs of their local populations and to expand mental health services in line with the aims of the Long Term Plan and the NHS Mental Health Implementation Plan 2019/20 – 2023/242, which provides the framework for local delivery.
1 https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf 2 https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation- plan-2019-20-2023-24.pdf
Growth of the mental health workforce, as well as retaining and re-skilling our current workforce, is the key strategic priority to ensure we can deliver our commitments to expand services and increase access. This is why, through the Plan we are committed to expanding the NHS workforce, with an aim of having an additional 27,000 mental health professionals by 2023/24, to deliver the expansion and transformation of mental health services, including those for children and young people.
We are making progress: June 2022 figures show an increase of almost 6,900 more (a 5.4% increase) full-time equivalent staff in the mental health workforce compared to June 2021, and over 14,500 more (12.2% increase) since June 2010.
Furthermore, we are aware that the pandemic has posed significant challenges to children and young people’s sense of wellbeing, and data from NHS Digital3 shows the prevalence of mental health issues in children and young people has increased from one in nine in 2017 to one in six in 2021/22.
This is why, in 2021/22 we provided an additional £79million to expand children’s mental health services, allowing around 22,500 more children and young people to access community health services, 2,000 more to access eating disorder services, as well as a faster increase in the coverage of mental health support teams in schools and colleges. There are currently 287 mental health support teams supporting schools and colleges, covering 20-25% of the country, with 13 planned or in operation across the Sussex integrated care system.
NHS England also announced a further £40 million in 2021/22 to address the COVID impact on children and young people’s mental health. As part of this, £10 million capital funding was used to provide extra beds at units which provide care for young people with the most complex needs, as well as £1.5 million to ensure there are additional facilities for children under 13 years of age.
With regard to children and young people’s mental health services in West Sussex, in preparing this response, Departmental officials made enquiries with NHS England (NHSE), as well as the relevant regulator in this instance, the Care Quality Commission.
Officials inform me there is multiagency work across the Sussex integrated care system (which comprises East Sussex, West Sussex, and Brighton and Hove), under the leadership of the Directors of Public Health, to rapidly identify clusters of young people engaging in suicide ideation and self-harm, and to provide an immediate response to identify those at risk. Local Authority Safeguarding and CAMHS teams are working in partnership to assess individual risk and vulnerability and are establishing care management plans to support the young person at home and at school.
There are plans in place across the integrated care system to progress the Single Point of Access (SPOA) service, which will provide a simplified single route to access specialist emotional wellbeing and mental health support.
The SPOAs are providing an access point for clinicians and professionals to refer children and young people to the full range of emotional wellbeing and mental health services, including CAMHS. Young people and families may also self-refer and contact the SPOA for advice and guidance. It is anticipated that signposting children and young people to the right service for their needs at the earliest point will result in a faster process.
3 https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and- young-people-in-england/2021-follow-up-to-the-2017-survey
More broadly, NHS England consulted on the potential to introduce a range of new waiting time standards as part of its Clinically-led Review of NHS Access Standards4. These include:
• For an ‘urgent’ referral to a community based mental health crisis service, a patient should be seen within 24 hours from referral, across all ages;
• For a ‘very urgent’ referral to a community based mental health crisis service, a patient should be seen within four hours from referral, for all age groups;
• Patients referred from Accident and Emergency should be seen face to face within one hour, by mental health liaison or children and young people’s equivalent service; and
• Children, young people and their families/carers presenting to community-based mental health services, should start to receive care within four weeks from referral.
NHS England published in February the outcomes of its consultation on the potential to introduce these waiting time standards5 and we are now working with it on the next steps.
Finally, we launched a public call for evidence on what can be done across government in the longer term to support mental health, wellbeing and suicide prevention. We asked the public for their views on a wide range of questions, from prevention through to acute mental health care. This is a key part of our commitment to ‘level up’ and improve unequal outcomes and life chances across the country. The call for evidence closed on 7 July 2022. We are currently analysing the responses.
I hope this response is helpful. Thank you for bringing these concerns to my attention.
Kinds regards,
MARIA CAULFIELD MP
4 https://www.england.nhs.uk/clinically-led-review-nhs-access-standards/ 5 https://www.england.nhs.uk/wp-content/uploads/2022/02/mental-health-clinically-led-review-of- standards.pdf
Thank you for your letter of 7 August 2022, to the Secretary of State Steve Barclay, about the death of Robyn Skilton. I am replying as Minister with responsibility for Mental Health, and I thank you for the additional time allowed.
Firstly, I would like to say how deeply saddened I was to read of the circumstances of Ms Skilton’s death. I can only begin to imagine how distressing her death will be for her parents and those who knew and loved her. I offer my heartfelt condolences.
It is vital that we take the learnings from what happened to Miss Skilton to prevent future deaths, and I am grateful to you for bringing these matters to my attention.
I appreciate your concerns about access to child and adolescent mental health services (CAMHS) in West Sussex, and I would like to assure you that we are working nationally to support local areas to expand mental health services so that more people can access the care and support they need.
The NHS Long Term Plan1, which we published in 2019, commits to increasing funding for, and access to, mental health services, with at least an additional £2.3billion a year being invested into these services by 2023/24. This increased investment will allow an additional 345,000 children and young people access to mental health services by then.
A significant portion of this funding is provided through baseline funding to local commissioners (formerly clinical commissioning groups and now through the integrated care boards that replaced them). This is supporting them to deliver on their responsibilities to commission healthcare services that meet the needs of their local populations and to expand mental health services in line with the aims of the Long Term Plan and the NHS Mental Health Implementation Plan 2019/20 – 2023/242, which provides the framework for local delivery.
1 https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf 2 https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation- plan-2019-20-2023-24.pdf
Growth of the mental health workforce, as well as retaining and re-skilling our current workforce, is the key strategic priority to ensure we can deliver our commitments to expand services and increase access. This is why, through the Plan we are committed to expanding the NHS workforce, with an aim of having an additional 27,000 mental health professionals by 2023/24, to deliver the expansion and transformation of mental health services, including those for children and young people.
We are making progress: June 2022 figures show an increase of almost 6,900 more (a 5.4% increase) full-time equivalent staff in the mental health workforce compared to June 2021, and over 14,500 more (12.2% increase) since June 2010.
Furthermore, we are aware that the pandemic has posed significant challenges to children and young people’s sense of wellbeing, and data from NHS Digital3 shows the prevalence of mental health issues in children and young people has increased from one in nine in 2017 to one in six in 2021/22.
This is why, in 2021/22 we provided an additional £79million to expand children’s mental health services, allowing around 22,500 more children and young people to access community health services, 2,000 more to access eating disorder services, as well as a faster increase in the coverage of mental health support teams in schools and colleges. There are currently 287 mental health support teams supporting schools and colleges, covering 20-25% of the country, with 13 planned or in operation across the Sussex integrated care system.
NHS England also announced a further £40 million in 2021/22 to address the COVID impact on children and young people’s mental health. As part of this, £10 million capital funding was used to provide extra beds at units which provide care for young people with the most complex needs, as well as £1.5 million to ensure there are additional facilities for children under 13 years of age.
With regard to children and young people’s mental health services in West Sussex, in preparing this response, Departmental officials made enquiries with NHS England (NHSE), as well as the relevant regulator in this instance, the Care Quality Commission.
Officials inform me there is multiagency work across the Sussex integrated care system (which comprises East Sussex, West Sussex, and Brighton and Hove), under the leadership of the Directors of Public Health, to rapidly identify clusters of young people engaging in suicide ideation and self-harm, and to provide an immediate response to identify those at risk. Local Authority Safeguarding and CAMHS teams are working in partnership to assess individual risk and vulnerability and are establishing care management plans to support the young person at home and at school.
There are plans in place across the integrated care system to progress the Single Point of Access (SPOA) service, which will provide a simplified single route to access specialist emotional wellbeing and mental health support.
The SPOAs are providing an access point for clinicians and professionals to refer children and young people to the full range of emotional wellbeing and mental health services, including CAMHS. Young people and families may also self-refer and contact the SPOA for advice and guidance. It is anticipated that signposting children and young people to the right service for their needs at the earliest point will result in a faster process.
3 https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and- young-people-in-england/2021-follow-up-to-the-2017-survey
More broadly, NHS England consulted on the potential to introduce a range of new waiting time standards as part of its Clinically-led Review of NHS Access Standards4. These include:
• For an ‘urgent’ referral to a community based mental health crisis service, a patient should be seen within 24 hours from referral, across all ages;
• For a ‘very urgent’ referral to a community based mental health crisis service, a patient should be seen within four hours from referral, for all age groups;
• Patients referred from Accident and Emergency should be seen face to face within one hour, by mental health liaison or children and young people’s equivalent service; and
• Children, young people and their families/carers presenting to community-based mental health services, should start to receive care within four weeks from referral.
NHS England published in February the outcomes of its consultation on the potential to introduce these waiting time standards5 and we are now working with it on the next steps.
Finally, we launched a public call for evidence on what can be done across government in the longer term to support mental health, wellbeing and suicide prevention. We asked the public for their views on a wide range of questions, from prevention through to acute mental health care. This is a key part of our commitment to ‘level up’ and improve unequal outcomes and life chances across the country. The call for evidence closed on 7 July 2022. We are currently analysing the responses.
I hope this response is helpful. Thank you for bringing these concerns to my attention.
Kinds regards,
MARIA CAULFIELD MP
4 https://www.england.nhs.uk/clinically-led-review-nhs-access-standards/ 5 https://www.england.nhs.uk/wp-content/uploads/2022/02/mental-health-clinically-led-review-of- standards.pdf
Report Sections
Investigation and Inquest
On 10 May 2021 I commenced an investigation into the death of Robyn Lily Audrey SKILTON aged 14. The investigation concluded at the end of the inquest on 28 June 2022. The conclusion of the inquest was that: Robyn took her own life whilst struggling with her mental health. The mental health services failed Robyn as they did not recognise the deterioration of her mental health nor provide her with the care and treatment she required. Her death was contributed to by neglect.
Circumstances of the Death
On 7th May 2021 Robyn Skilton was found in Southwater Park, having tied a ligature around her neck. Emergency services were called but death was confirmed at 1251 hrs. Robyn had a history of mental health problems which included self harming. Despite her deteriorating mental health, at the time of her death, she was still awaiting a formal assessment by a Child Psychiatrist.
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Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.