Your last question is the easiest one, which is no, there isn't consistent practice across Wales. There are areas that work best. I think the key thing to all of this was emphasised in the last answer to the last question, actually: services work better when professionals know each other and have a really low threshold for being able to talk to each other. And, in the past, we've had a model that was very much transactional, about booking an out-patient appointment, and actually that's the end bit of the service, not the thing that's necessarily the most helpful. So, in this, in our work with schools, in our work with CAMHS, in our work with youth justice, what we try to do is we try to make sure that we have regular contact and relationships with the necessary therapists.
So, Adam has outlined how, in Gwent, we have speech and language therapists, we have mental health practitioners, and we're trying to map—. I should add that I'm also the designated education clinical liaison officer for Gwent. I'm a child psychiatrist who provides the psychiatric input into the youth justice team, and I also was, until just prior to lockdown, head of family and therapy services and deputy chair of the Gwent partnership board. We've been trying to work so the health offer isn't simply a referral and appointment basis, but is one that actually says that the first health offer is knowing your therapist, knowing your professional so that you can, at any time, pick up the phone and say, 'Look, I'm concerned about this young person, what should I do?', which then has a secondary layer of training, which then has a third layer of, 'I'll see this child alongside you and give you some advice.' And, if you like, it's not until layer four we talk about getting people into clinic, because the children who are most vulnerable and carry the most vulnerabilities often struggle to come to a clinic appointment due to the nature of their lifestyles. So, we actually need to not only front-load the input but actually move our input to where the young person is.
And there are several health boards across Wales that, in different sorts of specialties, are developing that sort of model. Mental health is probably the furthest along, because it's actually enshrined in the way of working, but speech and language, occupational therapy, lots of those services are trying to move things forward. The key is: first of all, have you got the capacity and space to do it, have you got the right staff to do it; and secondly, there is an issue about physical recruitment. There is big recruitment [correction: There is a big recruitment challenge in Wales] for every single professional, actually having people on the ground to deliver it. This form of work, i.e. working virtually through Zoom and through Teams, allows you to make sure that that expertise can be as flexible and far-reaching as possible. It works very well when you already know the team; it's a little bit slower developing those trusting relationships to be able to just pick up the phone and ask Pippa or Adam, 'I've just seen somebody, could he have it?'