19.4 When the Review commenced, access to the specialist GIDS service was unusual in that the service accepted referrals directly from primary care (a GP) and from non-healthcare professionals including teachers and youth workers.
19.5 The audit of GIDS discharge notes, undertaken by Arden & Gem CSU in spring 2023 (Appendix 6), found that 48.6% of patients referred to GIDS were referred by CAMHS/ child and young people mental health services and 40.68% were referred by their GP. Of the remaining, referrals were made by other healthcare providers (2.6%), local authorities (3.3%), the voluntary sector (3.1%) and schools (1.8%).
19.6 This created a number of problems:
The information recorded on the referral was highly variable and often lacked even the basic information that the specialist team would need to screen and triage the patient.
Patients who would not usually meet the threshold for a specialist service were being referred, meaning waiting times increased for everyone without a way to discern those who genuinely required specialist input from those who could be managed in secondary care or even primary or community care.
Once referred, it was unclear who held clinical responsibility for the care of the young person.
Usual assessments that would be undertaken by a secondary care practitioner (for example, safeguarding assessment, mental health assessment) were not being completed for these young people, particularly those referred through a non-healthcare route. This means that there is an unknown level of risk inherent in the legacy waiting list, that is, it is not known which young people may be at risk of self-harm or suicide, and which may be at risk due to family breakdown or other safeguarding issues.