From George Freeman MP Minister for Life Sciences Department Department Freeman MPST(his gsi-go1.uk for Business of Health Innovation & Skills Miss Stephanie Haskey HM Assistant Coroner Nottinghamshire 25 The Council House Old Market Square Nottingham NGI 2DT 13 August 2015 Miss Haskey, Thank you for your letter to Secretary of State about the death of Emma Carpenter: [was saddened to read of Emma s death: Please pass condolences to her family and loved ones. Your report detailed the treatment received by Emma over the course of her illness, culminating in her death in November 2006. Some of the concerns You noted in Emma' s case were: A lack of inpatient bed provision for mentally ill children and adolescents (including those suffering eating disorders) Lack of funding for school nurses (although it is important for them to attend Multi-disciplinary meetings). In the absence of school nurses, there are no clear connections between mental health professionals and the education system: On the issue of in-patient bed provision, DH provided NHS England with E7million in 2014/15 in response to an NHS England Tier 4 Report; published in July 2014. This funding was to provide: around 50 extra Children and Adolescents Mental Health Service (CAMHS Tier 4 beds for young patients in the areas with the least provision (South West and Yorkshire). Also additional case managers, new standardised access protocols throughout the country, and a new case management system to make the best use of existing resources. More than 60 new beds have been commissioned, bringing the total to over 1,400 beds, the highest this has ever been: Out of these 232 are reserved for patients with eating disorders. Some general children and young people'$ mental health units also treat disorders therefore the numbers are likely to be higher at varying times of the year 1sW my eating

Future in Mind' (March 2015), in response to the work of the Children and Young People s Mental Health and Emotional Wellbeing Taskforce established a clear and ful consensus about change across the whole system to improve children and young people's mental health and wellbeing: The Government has confirmed its commitment to take forward the ambition set out in Future in Mind and we are making progress, including: 1 . NHS England has distributed E3Om of funding this year; fically to improve eating disorder services. NHS England and the National Collaborating Centre for Mental Health published on 3 August 2015,a commissioning guide for clinical commissioning groups (CCG)s which sets out how to prepare for the access and waiting time standard for Children and Young People with an Eating Disorder ready for implementation from
2017. 2_ The sooner someone with an eating disorder starts an evidence-based NICE- concordant treatment the better the outcome_ The standard is for treatment to be received within a maximum of 4 weeks from first contact with a designated healthcare professional for routine cases and within week for urgent cases. In cases of emergency, the eating disorder service should be contacted to provide support within 24 hours. We are working toward the majority of admissions meeting these standards. 3_ On 3 August 2015, NHS England published guidance, backed by additional investment; asking Clinical Commissioning Groups to continue and accelerate intensive work with local partners across the NHS, public health; children's services and education sectors to jointly develop and take forward local plans to transform the local offer to improve children and young people's health and wellbeing: Health Education England (HEE) was established to deliver a better healthcare workforce for England and is accountable for ensuring & secure workforce supply for the future_ We have a responsibility for promoting high quality education and training that is responsive to the changing needs of patients and local communities and will work with stakeholders t0 influence training curricula as appropriate. In April 2014 Public Health England (PHE) and the Department of Health published guidance to commissioners for services to school aged children, Maximising the school nursing team contribution to the public health of school- children. At an England-wide level, during the 2014 planning round, NHS employers of school nurses indicated that currently have some high levels of vacancies_ power specit aged they

Department DeBrsiness of Health Innovation & Skills HEE $ Workforce Plan for England sets out our intention to commission 340 training places for school nurses in 2015-16, representing a 71.7% increase on last year; in order to support increased provider demand; all of whom will make important contributions to the health of the general population. HEE also intend to increase commissions for the four branches of nursing. Detail can be found in the table below. 72014/15 Planned 2015/16 commissions commissions % Increase Adult Nurses 13,228 13,783 42 Children's Nurses 62,182 62,343
7.4 LLearning_Disabilities Nurses 1653 1664 1,.7 Mental Health Nurses 3,143 3,243 /3.2 Lastly, HEE plans to undertake a term piece of work to review curriculums of all National Health Service commissioned training programmes to include recognised areas of health including learning disability, mental illness, physical illness and physical ill health and social support needs. HEE will work with regulatory bodies including the NMC to agree the standards and content for education and training, this is anticipated to be completed by April 2017. hope that this information is useful. Thank YOu for bringing the circumstances of Emma death to our attention.

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Mind' (http Iwww future-in-mindcoukl) jointly chaired by the Department of Health and NHS England The Future in Mind report establishes clear and powerful consensus about how to make it easier for children and young people to access high quality mental health care when need it, It looks at whole system, multi-agency responses from early intervention to supporting children and young people with the most severe needs_ 2_ Current action to improve access to evidence based eating disorder treatment and continuity of care throughout a young person's care path: NHS England is investing E3Om per year for Clinical Commissioning Groups (CCG's) to develop and deliver evidence based community Disorder services. This funding is in addition to resources already in place to deliver treatment for young people with eating disorders. In July 2015 NHS England published an access and time standard and commissioning guidance on how additional funds are to be used to commission evidence based community Eating Disorder services for children and young people (bttp Ilwww bingcom/search2q-accesstand-waitingttimetstandardtfortchildrentandt youngtpeopletwithtanteatingtdisorder&srczIE IopResu&EQRM-IELOTR&adlizstrict) This is to support CCG's preparation to meet new standard for evidence based eating disorder treatment to be delivered within maximum of 4 weeks from first contact for routine cases and 2 weeks for urgent cases: The first target for the standard is to be implemented from April 2017-18. The community eating disorder model of care sets out how evidence based advice_ consultation and treatment is to be accessed easily by those who are concerned; this is to include self-referral for young people or concerned parents as well as school staff and GPs The aim is to ensure that the broad and varying needs of a child or young person with an eating disorder, as well as the needs of their family or carer, are met as soon as need or concerns arise_ In your report you highlight the significant gaps in communication concerning the severity of her condition and how this contributed to the breakdown of care_ The eating disorder guidance emphasises the role of community eating disorder services to provide oversight and support throughout young person's care path including times of admission to a paediatric ward or inpatient CAMHS unit CCG's are currently developing local plans for how they will enhance or develop community eating disorder services for children and young people and will be able to access funding from NHS England from September 2015.
3. Work to improve links and communication between CAMHS and schools and improve mental health awareness and knowledge among school staff Over the last few years there has been range of initiatives to improve understanding of school staff about mental health issues and to improve communication; These include: High quality care for all, now and for future generations they Eating waiting the the

MindEd e-portal (bttpsILWWminded_orgUkl) which includes e-learning sessions specifically on eating disorders to improve mental health awareness and knowledge school staff. Department of Education's publication on Mental Health and Behaviour in Schools (https /lwww_gov uklgovernmentpublications/mental-health-and: behaviour-in-schogls-2). Public Health England' $ guidance on Promoting Emotional Health and Wellbeing in Schools (https IlwwWgOV uklgovernmentlpublicationslpromoting-children-and young-peoples-emotional-health-and-wellbeing) NHS England are about to pilot an initiative with the Department for Education to develop a programme for single points of access in Tier 3 (specialist community) CAMHS and schools, testing it over at least 15 CCGs_ The training will be for an identified member of staff from the NHS CAMHS team plus a member of the school staff and additional colleagues such Special Educational Need Co- ordinators, school nurses and counsellors. This is linked to recommendation from Future in Mind_ The Spring Budget allocated E1.5 million to support this pilot over the next year July 2015 to June 2016. NHS England is committed to improving children and young people's mental health services across the whole care pathway no matter who is the responsible commissioner. This will include young persons with eating disorders We that the above information addresses your concerns and that this provides reassurance that NHS England is taking not only immediate necessary action but investing in both inpatient and community provision that affects young person's care pathway within mental health.

Dear Miss Haskey Further to the Regulation 28 Report to Prevent Future Deaths (PFD) Letter, issued on 14 July 2015 following the inquest of Emma Carpenter, would like to apologise for the in our response to you: While we had no involvement in this case, we have been requested through this PFD to engage with the Eating Disorder Service provided by Nottinghamshire Healthcare Trust: wish to confirm that this Trust has communicated formally to Nottinghamshire Health Care Foundation Trust, to understand how we can support patients from the Bassetlaw area whilst receiving treatment in Thorneywood Adolescent Unit. We offered formal service level agreement and a named consultant to be the link to the service_ The response Deputy Director Local Services Division at Nottinghamshire Healthcare Trust was: "Thank you for your letter of 2Oth July 2015 regarding the Regulation 28 Following our conversation, we cannot anticipate any regular requirement from Doncaster and Bassetlaw Hospitals NHS Foundation Trust to provide paediatric support at Thorneywood Adolescent Unit: am sure it would be adequate to agree any paediatric advice on @ case by case basis should this ever be required. Please do back to me If you need anything else. We have an identified Consultant and will actively engage with the services provided by Nottinghamshire Healthcare Trust as the need arises and will monitor these arrangements through the paediatric clinical governance team: As a Trust we are committed to improving our services and working actively with other provider organisations in the health community.