Janette Fullwood, Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) to provide an update on the refreshed multi-stakeholder LTP for children and young people’s mental health and wellbeing and the new governance arrangements for the delivery of the plan and new outcomes.
Janette Fullwood, Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) provided an update on the refreshed multi-stakeholder Local Transformation Plan (LTP) for children and young people’s mental health and wellbeing and the new governance arrangements for the delivery of the plan and new outcomes.
Janette Fullwood, Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) Introduced herself to the Panel and explained that:
· Mental health for children and young people was a significant and growing issue.
· 1 in 8 children had a diagnosable mental health condition whereas previously it had been 1 in 10.
· Locally the Child and Adolescent Mental Health Services (CAMHS) were seeing more complex cases and raised numbers of cases.
· There was some good news nationally following the Green Paper and the Government had committed to invest in new mental health teams locally.
· Since last February 2018 when she had started her role, the system was now working in an integrated way, with budgets and resources working together.
Background was provided to the LTP. It was explained that:
· The LTP was not new and had originally been part of a document called “Future in Mind” produced in 2015 which had set out how, as a system, local services could would work together to deal with mental health and emotional wellbeing.
· East Berkshire’s first LTP had 9 strategic priorities. This plan had now been refreshed in a multi agency way.
· The new LTP was 80 pages long.
ACTION: Janette Fullwood Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) to provide the link to the full LTP to the Panel
· The refreshed LTP had been signed by all directors of children’s services.
· The CCG lead the plan but the whole system now worked together.
There were some highlights of the new approach:
· Additional services, including online support and community counselling across the patch had been commissioned (KOOTH).
· Psychological Perspectives in Education and Primary Care (Ppep Care) training had been delivered to professionals including GPs and teachers, upskilling the workforce.
· An eating disorder and rapid response service for those presenting in crisis was now in place.
· The increase in tier 4 admissions, for those who were most unwell and needed inpatient admission, had slowed and the average length of stay was reduced.
The current challenges with the LTP were described:
· There was a fragmented offer for children and young people who didn’t always know where to go for help resulting in extra pressures for specialist CAMHS.
· Approximately 50% of the referrals were inappropriate referrals, because of fragmented services.
· More work needed to be done with parents and carers to develop their participation. Co-production with these groups was necessary. The Special Educational Needs Service (SEN) was much more advanced in this area.
· The previous plan had looked at what needed to be commissioned not at how the system was working.
· This year there was is just over £1m allocated to this work. The focus was not just about spending money but working better to achieve better results.
· The previous LTP had 9 strategic performance indicators.
· The current LTP had been stripped back to 4 key priority outcomes and enablers, and there were now deliverables and measures.
· The new LTP was aligned to partners’ priorities and strengthened the multi agency arrangements.
· Conversations had begun about the amount of funding and what others would potentially match, using existing funding not additional money.
· The 4 new outcomes were high level statements. Behind each were deliverables and measurements.
· Of note, the early intervention offer needed to be developed.
The governance arrangements for the LTP were outlined:
· The governance arrangements had been a significant development.
· Previously the LTP was not multiagency and the new governance arrangements now lead to the right people to make decisions, reporting to the Joint Commissioning Board Children and Young people (CYP) Health and Wellbeing East Berkshire.
· Young Health Champions were being proposed.
The next steps for the LTP were described:
· The new multi stakeholder LTP group was now set up.
· Thom Wilson, Assistant Director: Commissioning was the local representative.
· Together with Chris Stannard, Public Health Programme Manager, Thom Wilson and Chris Stannard were the links and would provide feed back.
· Monthly meetings would take place to progress work at pace.
· Each meeting would have a theme. The January meeting would be to progress conversation about developing an early intervention model of support, putting the local authority in control of co-design for what an early intervention model would look like.
· Going forwards for phase 2, the LTP would be looking at supplying mental health support teams.
· Currently a date cannot be given to when Phase 2 will be activated but the system is ready to apply for it.
Arising from Member questions, Janette Fullwood, Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) explained:
· Specialist CAMHS provided a whole spectrum of specialist services but approximately 50% of the East Berkshire children and young people referrals, had been referred to this service inappropriately.
· if a young person didn’t meet the referral threshold for CAMHS, East Berkshire Healthcare didn’t just send their referral back, they were good at signposting to appropriate services such as KOOTH and Youthline.
· The common point of entry (CPE) for the initial referrals needed to be understood better and this was a priority area.
· There had been a big increase in anxiety amongst children and young people.
· The easting disorder service had been commissioned for 100 referrals per year but was over that number already. Those individuals were also complex, really unwell people.
· Work needed to be done on other parts of the system to pick up the indicators of eating disorders and the system needed to work together better.
· Very little quality quantitative data existed on eating disorders. The commissioning of the service for 100 people was taken from those who were children and young people already in specialist services, and projections were made.
· As the service became known, there was a spike in demand.
· The CCG was now looking at future service provision for eating disorders and there was a section in the NHS 10 year plan that deals with eating disorders.
· The previous service was commissioned based on limited available data.
· The CCG was now doing a wider, whole system piece of work now to look at early intervention and prevention.
· Quarterly performance meetings were held jointly with the CCG and Public Health to monitor the effectiveness of KOOTH
· The CCG part funded KOOTH across East Berkshire, but Public Health provided a larger amount of funding to KOOTH in Bracknell Forest.
· Data from KOOTH was some of the best quality data the CCG had.
· Chris Stannard, Public Health Programme Manager provided a quarterly update on KOOTH.
· KOOTH had taken off in Bracknell Forest more significantly than in the other two areas because Public Health had communicated and backed it in schools within the Borough.
· Consistent and continuous communications about KOOTH were a big issue and essential for its continued success.
· Focus groups from young people, mentioned peer communication as being a key influencer.
· Educating young people about KOOTH and spreading the word could be done by young health champions and training for Year 12 children would take place to set up wellbeing groups in schools to help spread the word.
Nikki Edwards, Executive Director: People
added some further detail relating to KOOTH:
Innovative ways to engage with young people, across things such as social media were being looked at.
· 167 young people logged on to KOOTH in Q2 2018-19.
· 2700 young people had logged on to KOOTH since April 2015.
· 86% of people made a return visit to the KOOTH website.
· 35% of young people went on to be registered for formal counselling.
· Family hubs had targeted youth workers who worked within schools and who did one to ones.
· KOOTH was an online emotional help information service. It had forums, messaging capability, instant help, articles to read, and an online counselling service.
· It provided a choice and opportunity for lots of young people to raise mental health issues.
· People logging on to KOOTH were using the system.
· There were rising numbers of people with mental health needs and KOOTH provided 24/7 access without a wait.
· KOOTH was a national organisation. Young people could log on to KOOTH by Googling the search term ‘KOOTH’ and registering.
· KOOTH could be accessed by care leavers, up to the age of 25.
· Young People trusted KOOTH. It was a safe online environment.
Janette Fullwood, Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) took further Members’ questions and explained:
· There were not too many agencies trying to work together. The challenge was how to get all of the agencies to work together effectively.
· Having a single point of access for people was the issue. For parents, children and young people and GPs the system didn’t work together well enough and needed to work in a more integrated way.
· The early intervention model was key.
· Things needed to be better joined up and more integrated with shared responsibility in the system.
· KOOTH results were measured by performance reports, measured by reach, evidence based outcomes in terms of counselling, feedback and the friends and family test.
· The effectiveness of KOOTH on individuals was measured by goal based movement, how a person felt at the start of their contact with KOOTH versus how they felt at the end of the process.
ACTION: Janette Fullwood, Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) in consultation with Chris Stannard, Public Health programme Manager to provide a synopsis of performance monitoring data on KOOTH to circulate to Panel members.
ACTION: Members to log on to KOOTH and have a look at www.kooth.com
· The Integrated Care System (ICS) had a Children, and Young People work stream.
· Under this work stream there were 3 specific areas:
o Urgent Care
· The LTP was linked to that agenda.
· East Berkshire had historically looked to West Berkshire but was now starting to look to the ICS colleagues for cooperation and development. With eating disorders, for example, East Berkshire were looking towards their colleagues in Surrey and trying to learn from them. They were looking towards their colleagues in Hampshire to learn about autism support.
· The ICS had created opportunities, but local authorities were very different.
· Locality bases needed to be right across East Berkshire.
· The fragments in the system had been examined and the CCG had identified
· shared synergies and gaps in each locality.
· Led by the CCG, Bracknell Forest was a key voice around the table to fill the gaps and the achievements in the last 6 months had been impressive.
Tony Dwyer, Locality Manager advised that:
· All services (such as the police) were working closer with South Central Ambulance Service (SCAS).
· Street triage workers worked with police on response calls to help deal with mental health issues.
· In terms of children and young people rapid response, the majority were presenting at A&E and that needed to be examined.
· A rapid response service had been commissioned but was it right? The challenge was how the whole service spectrum was achieved.
· Strong arrangements were in place for to comply with Data Protection legislation.
The Chairman thanked all those who had contributed for being frank about the challenges they faced and asked Janette Fullwood, Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) what other good news would she anticipate in the next year.
In response, Janette Fullwood, Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) advised the panel that she hoped to:
· Create a legacy.
· Create a strong early intervention offer within East Berkshire with one point of access, but that might be a hope too far as there were 3 very different local authorities.
· Provide the knowledge to young people so that they knew where to go immediately when they were dealing with mental health needs rather than having to wait a number of months, as this had a significant impact.
· Move away from a medical model.
· Listen and act upon what children and young people saying based on feedback from them.
· Continue to give young people a voice in the system. Peer referrals and safe self referral was a really good thing.
The Chairman thanked Janette Fullwood Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group (East Berks CCG) for her update and for attending the Panel .