Agenda item

Report of Associate Director Central Locality Community Services, CNTW NHS Foundation Trust

Committee received an update report on the delivery of children and young people’s Mental Health services (CYPS) in Gateshead.

The report to Committee in 2018 outlined the proposals including; establishment of a single point of access (SPA), access to KOOTH, development of new service specifications based on the Thrive model, a move towards more intervention and prevention and the introduction of lead provider arrangements from April 2019.

From 1 April 2019 the new lead provider model went live. The aims of this model are to move towards an early intervention model and to monitor activity as a whole system.

Cumbria, Northumberland, Tyne and Wear Foundation Trust (CNTW) are leading the work to transform the CYPS pathway. A number of providers are now coming under the lead provider model, including; Streetwise, Children North East, North East Counselling Services and Kalmer. Kooth and Barnardos will be coming under this model from October 2019.

The “getting help” and “getting more help” services was previously known as Tier 2 and Tier 3 services. Work is ongoing to flow patients more in to getting help service rather than getting more help, this is in line with the thrive model, which the service specification is based on. Monthly pathway meetings are held with all providers and providers are working more closely than ever before to ensure clients are seen by the right service first time.  Providers are also working collectively to reduce waiting times across the service. Regular pathway meetings have already led to improvement in the overarching pathway and significant improvements are emerging.

The NHS providers and the third sector providers are now working under NHS Standard Contracts, this is a 12 month contract from 1 April 2019.

It was reported that all services contracts receive their referrals through the single point of access (SPA).  SPA provides a fully integrated and direct clinician support for all providers, it is the first point of contact for all requests for advice and referrals. SPA offers a coordinated access to Getting More Help.  SPA is led by a clinician, this allows clinical decision making and interaction at the point of access and ensures referral to the right place first time.

Committee was advised that Kooth is an online platform which provides advice and guidance for young people. This is promoted in all schools and information on Kooth is given to children and young people upon referral to the SPA.

It was noted that CNTW have employed 12 trainee mental health workers to provide support to schools across Newcastle and Gateshead. The teams offer early intervention into schools, supervised by experienced mental health clinicians, for young people with mild to moderate mental and emotional health needs.

In terms of performance, data is now captured across all providers in Gateshead. The key focus is to ensure children are seen in the right place first time. Accepted referral rate is now 99%, this is as a result of the triage service within the SPA.  There has also been a significant reduction in the number of young people waiting over 18 weeks to be seen.

In relation to SPA referrals it was reported that the majority are from GPs, followed by self-referrals then education service referrals. On average 141 referrals per month are received from Gateshead clients.

It was noted that the aim is to have a DNA rate of under 16%, this is a contractual aim and a national requirement. Currently DNA rate is 18%, and work is ongoing to tackle this, for example offering evening and weekend appointments.

The number of young people waiting over 18 weeks has dropped and is now at 80. This has reduced a lot but it was acknowledged that there is still a lot to do, therefore there has been further investment into the third sector to enable more appointments to be offered.

Committee was advised that the lead provider model is working well, there continues to be significant work taking place to move activity out of the Getting More Help service to the Getting Help service with a focus on prevention.

It was questioned what circumstances are young people in who are waiting over 18 weeks to be seen. It was confirmed that it is predominantly those young people in the neuro development pathway, this is due to a tri-fold increase in this type of referral. This pathway is for those with or waiting for diagnosis of autism, ADD etc. It was noted that a lot of the wait is due to ASD cases which is also a national issue. There is a specialised team dealing with those waiting over 18 weeks and work is on target to reduce this.

It was queried whether working to 12 month contracts is risking continuity of provision of service and if there are plans in place to ensure continuity for those outside the NHS. It was confirmed that NHS contracts are generally only for 12 months and that the providers are working under standard NHS contracts.

It was questioned whether a young person would go back to the start of the waiting list if they did not attend an appointment. It was confirmed that the increase in DNA rates correlate with school holidays which also is when there is usually a spike in referrals, just before the holidays. Young people are more likely to be seen during school time, however if they do not attend a further appointment would be sent out, which is usually within two weeks.

It was confirmed that the Trailblazer work is underway in Heworth Grange and Lord Lawson and their feeder schools as well as in Jewish Primary Schools. Committee requested that further feedback on this work be reported on at a future meeting.

It was questioned what the longest wait for an appointment is. It was noted that previously the performance measure was 18-30 weeks wait, however nobody was waiting that long and ideally no one should be waiting over 18 weeks.  It was agreed that average wait times broken down into tier 2 and 3 will be provided next time.

The question was asked whether Kooth as a support mechanism solves any problems for young people. It was confirmed that there is evidence that there is a lot of young people dealt with through Kooth. Bytesize offers a similar service to younger children and Kooth is also currently looking to develop a younger model.

It was questioned whether there is any information around the outcomes for young people who have gone through the service. It was acknowledged that there are measures against clinical outcome scales and patient rate measure, however this information is not collated collectively. This does get fed through to the CCG on a percentage basis although it is difficult to capture outcomes in terms of mental health. National work is ongoing in terms of how to capture outcomes in the future.

Committee was concerned that there is still a lot of young people waiting a long time to be seen. It was acknowledged that there has been additional investment in this area as it is a national crisis due to years of under investment. There are examples of improvements and work is ongoing.

The point was made that previously there was no evidence of forward planning. It was confirmed that there is a long-term plan in place now which also provides a breakdown of expected children and young people who will require the service over the coming years in Gateshead. This therefore allows planning and investment to take place in anticipation.

RESOLVED    -           That the views of the Committee on the progress outlined in

the report be noted.