Document Sample
                         IN WALES

                 Held at The Lake Country House Hotel,
                      Llangammarch Wells, Powys

                            16th October 2009

1.    Present: Dr C Lamb (Chair), Dr A Ahuja, Dr C Ball, Dr H Barton, Dr H
Behi, Dr I Davey, Dr R Glaze, Dr M Griffiths, Dr P Halford, Dr A Hassan, Dr V
Padmanabhan, Dr R Potter, Dr S Roswana, Dr S Sharma, Dr D Williams, Dr A

2.     Apologies: Dr P Duthie, Prof R Williams, Dr R Bevan-Jones, Dr Peter
Gore-Rees, Dr H Holmes, Dr W Barber, Dr H Hayes, Dr A Goel, Dr H
Fitzpatrick, Dr R Ing, Dr K Lynch, Dr V Yadev, Dr T Lorenz, Dr P Rooth, Dr A
Darwiash, Dr G Davies, Dr S Henley, Dr T Munoz, Dr S Reddy, Dr M Hassan,
Dr A Sabir, Dr El-Syed, Dr A Price, Dr S Ames, Dr J Talbot, Dr G Salmon, Dr
C Fernando

3.    Minutes of last meeting – 17th April 2009
Minutes of last meeting were approved

4.     Matters Arising
Clare Lamb suggested that a slot for Trainees Issues to be included in future
meetings. Clare also enquired if the group had had any feedback on the
Section 136 work on designated place of safety which has been ongoing in
Wales. Claire Ball asked for an update on COMPASS and Clare Lamb said that
many of the clinicians were not filling them and she had been advised to wait
for further information from them.

5.     Chair’s Report

Dr Clare Lamb

Feedback from Welsh Division Exec.

Clare Lamb reported about the Executive meeting she attended and Siobhan
Conway will be sending the minutes of that meeting to the group. Issues
discussed included Approved Clinician approval and the FAIR DEAL campaign.
Chair of Welsh Division, Helen Matthews, attends the RCPsych Central
Executive Committee meetings in London. She had highlighted the issue that
the College deals mainly with English (DoH) policies and guidance. Helen is
working on getting cross jurisdiction issues into the college as most issues
discussed including training and professional development are based around
the English health policies. There is a Cross Jurisdiction body that has been
set up in the Central Executive Committee now.

Clare Lamb mentioned that the Head of Schools in Wales were working on
advertising the Welsh training posts across the country including England and
Dave Williams informed the group that this had happened recently and
resulted in better outcome.

Feedback from Child & Adol Faculty Executive

Clare Lamb informed that     the real focus of the faculty has been on workforce
related issues and Dave       Williams has linked into this work as well. The
Paediatric representative    from the Royal College of Paediatrics has shared
their experience and their   success in increasing their workforce last year.

Raphael Kelvin from the workforce committee has now been appointed as the
Department of Health policy advisor in England with a view to increasing the
number of higher trainees in Child and Adolescent Psychiatry. In his
document for the college (will be ready for the election) there will be a welsh
section as well including information on number of NTN trainees in Child and
Adolescent Psychiatry, number of new consultants and number of MDT staff

There has been extensive discussion on the the new training curriculum
which removes compulsory developmental placement (Child or LD) and
highlighted the need for all psychiatrists to gain experience in developmental
psychiatry. Brian Jacobs has been pursuing this issue further with the college
and the Child & Adolescent faculty will continue work with the College to
campaign for inclusion of developmental psychiatry into clinical training

The new chair of the Child and Adolescent faculty executive is Margaret

Other key items discussed were the ‘Consultation on Regional Rep’. Rob
Potter did not have any update and it appears it is still under consultation.
The regional rep is currently voted/chosen by peers in their division. Clare
Lamb mentioned that she had received feedback from the college last week
on this consultation and will be sharing it with the group (circulated by

6.    Treasurer’s Report

Dr Alka Ahuja

Alka Ahuja mentioned that the current balance to date was £1611.49.
Alka mentioned that the current balance reflects the increase in the meeting
fees and lack of expenditure on outside speakers.

7.    Regional Representative’s Report

Dr Rob Potter

Rob Potter mentioned that Sara Walker from Plymouth had been appointed
as the new chair of the regional representatives. The recent meeting of the
regional representatives had been poorly attended and all places except
Trent appear to have regional representatives. During the meeting the role of
regional representatives was discussed as there was some unclarity but now
a more explicit role had been discussed and Rob would share it with the
group once it was signed by the college.

Rob Potter had only heard of one consultant job being advertised so far
(which is sent to the regional advisor Dr Gary Sullivan and he forwards it to
the regional representative) but Rob was aware that other jobs had been
advertised without his knowledge such as the consultant job at the Vale and
the Mental Health Advisor post. Clare Lamb agreed to take this matter to the
executive body as there was lack of clarity on whether the two recent
consultant jobs mentioned above in Cwm Taf NHS Trust had actually been
approved by the Royal College and Rob Potter wasn’t aware of them being

Rob mentioned that he had only received a letter confirming his role as
regional representative four months ago and Clare Lamb would be looking in
this matter. Clare also will be writing to Gary Sullivan seeking clarification of
process around approval of future posts and enquiring whether there were
college approved job plans for the recently appointed consultant posts.

Rob was also trying to collate information on the impact of the budget cuts
on Child and Adolescent Psychiatry training.

8.    Training Programme Directors report

Dr Mark Griffiths

Current Trainee Situation:
8 currently in post ( 9 pots of money + 1 alternating pot shared with LD ):
1 North Wales Scheme; 7 South Wales Scheme
ST4s: Sam Roswana
ST5s: Callista Fernando; Izzy Davey; Rhys Bevan-Jones; Vineet
ST6s: Amani Hassan; Sanjeev Sharma; Habib Behi

Confusions regarding the North Wales situation have been recently discussed
& seem close to resolution.

New Appointments:
Interviews for 2 vacant posts held 17th Sept .
31 applied; 9 shortlisted; 5 attended interview; all deemed appoint able.
Dr Sushima Rao offered post (to start 1/12/09 as flexible trainee).

Dr Velandy cannot be offered the second post until it is confirmed that
funding will continue in spite of the fact that the Carmarthen post is currently
untenable. Dr Hasan is currently negotiating the issue with relevant parties.

New Curriculum:
The new competency-based curriculum was approved by PMETB in April 2009
& due to take effect from Aug 2009. Split into core & speciality curriculums
with a colour-coded system to guide the trainers.

Other Issues:
An e-learning sight has been set up for use by trainees & consultants across
Please log-on at www.mle.wales.nhs.uk

9. Tier 3 Forensic Services

Some of these issues had been discussed with Julie Withecomb during the
morning session. Dave Williams informed that Richard Williams had prepared
his first draft on Forensic and Transition issues and further work was planned
on Learning Disabilities and Substance Misuse services. There were also
plans to relook at the document on “Everybody’s Business” and to get
Education and Social Services involved in future Durham mapping exercises.

Clare Ball queried the role of the on call and community teams while dealing
with young people needing forensic input and she was informed by Clare
Lamb that if the young person has a need for specialist CAMHS input and is
based in the community or park Prison then her understanding was that tier
2/3 CAMHS services should be involved while the tier 4 forensic (FACTS)
services would be based on an All Wales plan. The South Wales consultants
stated that on call commitments would be as usual and there should be no
extra implications on the on call staff due to these issues.

10. Approved Clinician and Section 12 approval

Dave Williams Provided an update and mentioned that currently the
requirements for AC approval include an extensive gold standard portfolio
along with attendance at a training programme based in Wales. He
mentioned that this may be a temporary measure as in the future there will
be workstations developed to provide such skills. Professor Richard Williams
and Dave Williams have made recommendations to the Welsh assembly and
informed them that the use of the MHA for treating patients is rarely used by
the Child and Adolescent faculty. Some members of the group mentioned
that they had been given approval on other grounds.

Dave Williams informed that following a recent meeting with Sarah Watkins
(adult advisor in the assembly) and with other senior members it was felt
that in future if professionals are registered on the medical register they
would fulfil eight out of the nine competencies and would only need a letter
from their clinical director and attendance at an update MHA course. There
was discussion on how one would prove that they have used the MHA and
this could be achieved by a letter from the clinical director or attendance at a

skills based course. Also the approval panel should have a child and
adolescent psychiatry representative on it. In long term clinical vignettes
would be available online and there would be an option to attend a two day
course as well. Dave Williams mentioned that competencies would be based
on case vignettes or past involvement in MHA cases.

There is another course in North Wales in December and there are plans to
make it a generic course in future and add parallel sessions on transitions
issues, Human Rights Act etc.

Claire Ball expressed her concerns about the costs implications of future
courses. She informed that the recent course at the University Hospital of
wales in Cardiff was found to be expensive by the attendees (course fee
£425) compared to the courses conducted in England which are at half the
price or sometimes free.

Clare Lamb felt that the trust need to take the matter on as it is their
responsibility to maintain Section 12 approved and approved clinicians.

Amani Hassan mentioned that the cost of these courses was not included in
the SpR study leave budget and hence there had been issues for the SpRs to
get the required training especially if they had plans of taking up jobs in
England in the future.

Dave Williams agreed to write up the above information about the AC
approval process for Clare Lamb and it would be shared with this group as
well. In the meantime Sue Parsnidge or Hywel Huws need to be contacted
regarding any queries about Section 12 approval and letters should be copied
to Dave Williams as well.

11. Any Other Business


Clare lamb mentioned that in North Wales the CAMHS services were under a
lot of pressure from the adult services to extend their remit to include young
people upto the age of 18 years and a business case had been put forward.
Dave Williams mentioned that in Gwent they were planning to stay status
quo till the adult services had identified the needs of this group and extra
resources had been made available. He mentioned that this had been agreed
by Richard Williams as well. Although the Health and Well Being committee
encourages Transition service for this group and Everbody’s Business
mentions that by 2010 this should happen but there has to be discussion
about the resources required before this happens.

The ABM trust has protocols drafted for this group but there are no current
plans to expand the service in the ABM trust at the moment. Dave Williams
mentioned that guidance will be available in the next few months but
currently the focus needs to be on increase partnership working and
identification of training gaps.

Adult AOF targets

Clare lamb informed that she was the only CAMHS person on the WAG Task
Group appointed to work on intelligent targets and a policy document on
early intervention in psychosis and needed to submit her report by 22nd
October 2009. She referred to models proposed, resource implications. Some
propose separate designated service, other adult model proposed included
designated EIP sessions within their current CMHTs and designated CAMHS
sessions to link in with the virtual team model. It is hoped to propose a
model of having designated sessions of right expertise and skills from CAMHs
or Adult that meet the need of yp with 1st episode psychosis. There is a
model that is reported by Dave Williams to be working well in Gwent.

Clair Ball inquired about the LD services and was told that in the 10-12
months the LD strategy will be out and there appear to be plans similar to
the forensic model i.e encouraging generic specialist CAMHS (tier 2/3) to do
as much as possible at their level. There is a meeting planned with the HCW
end of November to discuss their current expenditure and how to use it to
develop local LD teams, specialist teams and regional teams. It would be
important to include Sundari and Steve Boyd in these discussions.

CAMHS Commissioning Networks

Currently referred to as CAMHS service planners will have three networks
and possibly new monies coming into it


Claire Ball enquired about its progress and was informed by Clare Lamb that
she was informed by Richard Williams that there is some work to be done on
it and it will be tried out in pilot areas initially and no active measures
needed to be taken by the group till they are contacted by COMPASS.

12.   Audit of Vacancies

Clare Lamb felt that Siobhan Conway did not have an updated list of all the
Child and Adolescent faculty members and it would be useful to spend some
time during the meeting to generate such a list as it would help inform
colleagues about future events.

Consultant Posts and Speciality Doctors (details included at end of

Conwy and Denbighshire 220,000 population
2.8 wte CAMHS. No vacancies.

North Wales Adolescent Service (Tier 4 CAMHS)
1.2 wte. 1 wte to be advertised
2 specialty grade doctor in post

Bangor 186,000 population
2.7 wte. No vacancies.

Flintshire 148,000 population
1.5 wte

Wrexham 150,000 population
0.8 wte and 1.0 vacancy.
0.8 wte Specialty Grade

Powys 126,000 population
1.4 wte. No vacancies.

Ceredigion, Pembrokeshire and Carmarthenshire
362,000 population
2.0 wte and 1.3 vacancy . No specialty grade doctors

Swansea, Neath and Port Talbot 360,000 population
3.6 wte and no vacancies. 1 Associate specialist

Cardiff and Vale 420,000 population
2.8 Community, 1 wte CITT and 1 wte vacancy (currently locum in post).
3 speciality grade doctors in post

Mid Glamorgan 440,000 population
4.4 wte and 1 wte CITT.
4 specialty grade doctors and 1 Associate specialist. 1 specialty grade doctor
vacancy temporarily.

Gwent 560,000 population
6.2wte and no vacancies.
0.5 specialty grade doctor

Tier 4 Forensic Psychaitry (all Wales)
1 wte

Tier 4 (Hafod Newydd)
1.5 wte and no vacancies
1 specialty grade doctor

Learning Disability

Conwy and Denbighshire
1 wte North Wales

0.2 wte

Higher Trainees

8 currently in post (9 pots of money + 1 alternating pot shared with LD ):
1 North Wales Scheme; 7 South Wales Scheme

13.   Dates of next meetings:-

             Friday 23rd April 2010

             Friday 15th October 2010

To be held at The Lake Country House, Llangammarch Wells, Powys.

Alka Ahuja will be writing to Siobhan Conway about the two dates for the
meetings next year and also asking the group on any suggestions for future
topics for the meeting next year. Some ideas shared by the group included in
Personality Disorders and Autism and there was talk about inviting outside
speakers if possible for future meetings.

Names of Consultant Posts and Speciality Doctors for email list:

Conwy and Denbighshire
Peter Gore-Rees
Helen Fitzpatrick
Clare Lamb
Robin Glaze

North Wales Adolescent Service (Tier 4 CAMHS)
Clare Lamb
Robin Glaze
Speciality grade doctors
Sri Velandy
Deepa Parri-Gupta

Kiran Lynch
Richard Ing
Vikram Yadev

Peter Roots
Tim Dyer

Tom Lorenz
Speciality grade doctors
Clare Toomey

Anna Pascal
Helen Hayes

Ceredigion, Pembrokeshire and Carmarthenshire
Cath Govan
Lynne Eve

Swansea, Neath and Port Talbot
Rob Potter
Andy Price
Gill Salmon
Sam Ames
Associate Specialist
Kim Billington

Cardiff and Vale
Azra Sabir
El Syed
Anna Goel
Helen Holmes
Ari Ubeseykara
John Talbot
Speciality grade doctors
Oscar Soales
Simon Halliday
Lisa Pregrine
Lokesh Nukulapati

Mid Glamorgan
S Reddy
Claire Ball
S Henley
Gill Davies
Pam Duthie
Tony Munoz
Specialty grade doctors
Sunil Pulapaka
Angela Dwyer
Mohammed Athar
Vikas Gupta
Associate specialist
Bilal Nimani
Gwent 560,000 population
Richard Williams
Dave Williams
Wendy Barber
Hilary Barton
Mark Griffiths
Alka Ahuja
Pia Menzies
Specialty grade doctor
Martha Morris

Tier 4 Forensic Psychiatry (all Wales)
Julie Withecomb

Tier 4 (Hafod Newydd)
Peter Halford
Ahmed Darwaish
Specialty grade doctor
Dinesh Murugenesan

Learning Disability
a) Conwy and Denbighshire
Steven Boyd
b) Gwent

Higher Trainees

South Wales
ST4s: Sam Roswana
ST5s: Callista Fernando; Izzy Davey; Rhys Bevan-Jones; Vineet
ST6s: Amani Hassan; Sanjeev Sharma

North Wales
ST6: Habib Behi


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