Agenda item

To provide a discussion on the refresh of the Mind Local Transformation Plan for Children's Mental Health.

Andy Fitton and Michelle Sancho introduced the Future in Mind Local Transformation Plan report (agenda item 11) which provided an overview of the refreshed Future in Mind Local Transformation Plan (LTP) which was published in October 2019 in accordance with national Future in Mind requirements. The LTP provided an update on service development and improvement across the comprehensive Child and Adolescent Mental Health Service (CAMHS) system.

Andy Fitton stated that Berkshire West CCG was continuing to make progress on the challenging area of emotional mental health. 

Key achievements/areas of strength included:

·         The impact of large scale training across partners could be evidenced.

·         Access to services by Children and Young People had increased again this year.

·         West Berkshire was one of 20 national trailblazer sites to set up Mental Health Support Teams in two local authorities.

·         More financial investment had been secured for the Eating Disorder Service.

·         West Berkshire was successful in becoming one of 9 pilot sites for a research project on improving mental health assessment for Children in Care.

Areas of challenge and development:

·         There had been an 8% increase in demand which in turn was having an impact on waiting times across providers. The demand was outstripping the ability to commission or recruit.

·         The rise in self-harm rates above the national average, particularly in the 15-19 year old age group, was particularly concerning.

·         Work was continuing to provide Tier 4 hospital beds as better capacity was required locally.

·         Some children and young people who were under specialist CAMHs continued to experience more severe symptoms and had more complex presentations than in comparator areas and this was particularly difficult to manage.

The LTP Plan had identified 7 priorities to focus on and would also act as a way to galvanise the partnership to collectively achieve improvement and change as follows.

Priority 1 – Ensure that we embed and expand the Mental Health Support Team in Berkshire West

Priority 2 – Continue to focus on meeting the emotional and mental health needs of the most vulnerable CYP with particular attention to Children in Care

Priority 3 – Continue to build a 24/7 Urgent care/Crisis support offer  for Children and Young People

Priority 4 – Continue to build a timely and responsive Eating Disorder offer

Priority 5 – Improve the Waiting times and Access to support, with particular focus this year on access to ASD/ADHD assessments and support

Priority 6 – To improve the Equalities, Diversity and Inclusion offer and access for Children and Young People in Berkshire West

Priority 7 – Building a Berkshire West 0-25 year old comprehensive mental health offer

Michelle Sancho stated that Berkshire West CCG was one of twelve trailblazers in a cohort of mental health support, delivering to 8,000 children in 3 secondary schools and 20 primary schools. A team had been set up which were working in a multi-agency joined up way.  A hard launch had taken place for the Mental Health Support Team with events being held in schools. New data systems had been put in place and work continued with partners to flow CYP access data onto the national dataset. Michelle Sancho commented that mental health support in West Berkshire was joined up and the Children in Care project was working well.

A three day training course on Therapeutic Training was taking place on trauma and how to work with young people. It was noted that there were no exclusions in the primary sector at present. All services were working in a complementary way and not in isolation.

Councillor Dominic Boeck thanked Andy and Michelle for the report.  He asked if there would be a merger between the Emotional Health Academy and the Mental Health Support Team. Michelle Santo responded that it would be a phased adjustment. The Emotional Health Academy and the Mental Health Support Team were doing different work at the moment but that might change over time.

Andrew Sharp raised concerns regarding where people would go if the EHA  pathway was not for them – the waiting list was long and people did not hear anything until about two weeks prior to their appointment. He asked if there was anything that could be done here. Andy Fitton agreed that waiting lists were too long but even if money was available there were still issues around recruitment. The issue was not just about waiting but more around what self-help or enabling that parents could do for themselves. Some pathways were long and digital assessments or telephone support was something that was being looked at. Michelle Sancho added that Mental Health Support Team and EHA should not have such a long wait time as the CAMHS pathway. Michelle Sancho stated that she was looking at the CAMHS and ADHD provision and the ability to provide provision without a diagnosis. Councillor Lynne Doherty felt that services should not wait for a diagnosis.

Dr Bal Bahia asked whether the Mental Health Support Team and the Emotional Health Academy were separate entities. Michelle Sancho responded that not every area had a EHA. West Berkshire had put in a bid for a Mental Health Support Team but there was an overlap and some flow between the two. Andy Fitton added that this was a new resource which was linked in with emotional health triage. It drew the resource closer to schools. However, the GP pathways remained the same.

Dr Bal Bahia asked for clarification as to whether the Eating Disorder service was based in Maidenhead. Andy Fitton confirmed that it was based in Maidenhead – it was a Berkshire-wide service but there was only one option across the area. Dr Bahia was concerned that it might be difficult for some people to get to. Councillor Martha Vickers said that it was worrying to hear that this important service was under strain and felt that it needed more resources. She also queried why there was such a high level of self-harm in this area. Councillor Martha Vickers asked if Andy Fitton had heard of Young Health Champions in schools. Andy Fitton responded that he had heard of them but that they were not used in this area. Michelle Sancho added that their role would not be to make referrals.  

Matt Pearce asked if it was possible to strengthen the role of the CCG in this. Kamal Bahia said that this was already an item on the agenda for the next meeting and she would link in with Andy Fitton to ensure that all the issues were picked up.

Councillor Lynne Doherty thanked Andy Fitton and Michelle Sancho for the report. She referred to a statement in the LTP which said that Children and Young People under CAMHS seemed to be more embedded in West Berkshire and she asked why that was the case. Andy Fitton replied that demand had increased provision which had uncovered more complex issues. 

Councillor Rick Jones noted that one of the challenges was around the complexity of the Berkshire West system and he wondered if anything could be done about that. Andy Fitton responded that decisions could be made on the footprint that was best suited. All three local authorities had the same responsibilities but delivered them in different ways and the key was how that footprint was managed. The CCG was facing a challenge as they were trying to coalesce three CCG’s. Cathy Winfield commended the work of the CCG. Bringing all the Directors of Children’s Services across all three unitary authorities together would present new opportunities for joint working and alignment.

Councillor Steve Masters noted that in the challenges it talked about the availability of skilled, qualified and experienced health workforce. He asked what measures were being put in place to mitigate that as the cost of living in this area was high.  Nikki Luffington advised that there was a focus on Children and Young People recruitment at present. Berkshire was very close to London and therefore some degree of salary enhancement might be required with a need to prioritise those posts which were most important. The incentives would be dependent on what people thought the priorities were, there were lots of initiatives at BHFT. Councillor Steve Masters asked what feedback had been received. Feedback had been mixed and would depend on the individual need e.g. relocation expenses or transport. They had been out to school and careers fairs, on social media and on the ground.

Garry Poulson referred to the issue around capacity and stated that there were volunteers but there would be a need to provide proper training and again resources would be required to do that. It would be useful to have a small sum of money available to do that. Michelle Sancho stated that there had been good voluntary sector input into triage which had been useful and worked well.