Dr. Amanda Burke:

I run a service that covers both urban and rural areas. If there are staffing deficits and a service does not have another area from which to draw to cover those deficits, it is a challenge. You cannot make two of yourself. If a core of clinical staff is spread around the place, it is far safer. From a governance point of view, we are going to have to tackle the model of care piece. It is not a popular piece to tackle because the same service cannot be provided in every geographical area. We know that has caused problems in the past because some people can feel they are not getting a good quality service if they do not have a CAMHS team on their doorstep. My view is that if a team cannot be filled and properly staffed over a number of years, the model of care must be examined and changed. We need to consider the evidence base and make evidence-informed decisions. The evidence base for therapy is provided by people who do a lot of the therapy and see conditions a lot rather than people who only see one or two cases per year. We need to assemble a cohort of people in a hub who can in-reach. I am not suggesting that we need young children to travel long distances. We can get our staff to travel or use a hybrid model. We could conduct clinics in different areas. We could also have centres of excellence for particular rarely occurring illnesses. For example, we need a good, solid programme for early intervention in psychosis, which is rare but very serious. We need to get in there early and take a solid and evidence-based approach. The same is true in respect of eating disorders. I favour a programmatic approach, which strengthens governance. However, to do that, we will have to take a hard look at the model we are pursuing at the moment, which is trying to provide everything everywhere.