In 2017, the Cheshire and Merseyside Health and Care Partnership Mental Health Programme Board (C&M MHPB) prioritised the development of a new model of care for the delivery of CAMH Tier 4 services in line with the national direction of travel towards the Five Year Forward View (FYFV, NHS England, 2016) and the NHS Long Term Plan (NHS England, 2019).

For some children and young people, admission to Tier 4 CAMHS is necessary and helpful, however for others admission it is neither necessary nor helpful and comes at a cost (Cotgrove & Northover, 2021). Therefore, the focus of the service change is to reduce avoidable admissions, enable shorter lengths of stay and end out of area placements.

A clinically-led, co-produced New Care Model was developed with all stakeholders including young people and families using an Appreciative Inquiry approach (NHS England, 2020).  The three main elements to the Cheshire and Mersey New Care Model are:

  1. Ancora Care: a Cheshire and Wirral Partnership NHS Foundation Trust hospital at home service for young people.
  2. Gateway meeting to ensure that all agencies take responsibility for young people at risk of admission to Tier 4 or receiving inpatient mental health treatment.
  3. Cheshire and Merseyside Children and Young People’s Complex Needs Escalation and Support Tool (CNEST) to provide an evidence-based way of identifying young people at risk of admission.

  • Whole family approach to care that meets individual need close to home and in the community where possible and appropriate
  • Person-centred approach - young people and their family’s needs, views and wishes are of paramount importance
  • Seamless care pathways with shared/multi-agency ownership, coordination, commitment and accountability to meet needs safely
  • Clear, unambiguous, open and seamless inter-agency communication, shared language and information sharing with clear roles and responsibilities of all professionals and family members in care planning and delivery of care
  • Standardised, equitable consistent approach across Cheshire and Merseyside providing the right care, at the right time, in the right place, by the right professional
  • Resilient, flexible, skilled and resilient workforce with mutual respect and support across disciplines
  • Formulated understanding of risk and challenges available to all involved