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Councillors and committees

Agenda item

Children and Young People Mental Health & Wellbeing Services

Report of Chris Piercy, Executive Director of Nursing, Patient Safety & Quality

Minutes:

The Committee received a report and presentation to provide an update on the delivery of Children, Adolescent Mental Health Services (CAMHS) in Gateshead.

 

An overview of the case for change was provided noting that the new model for service delivery assumes a conversion rate into treatment of 80% with the capacity required at “Getting Help” to be developed.

 

It was noted that current investment into the service is £7.4m (which included a £180k contribution from the local authority). Additionally, it was highlighted that there is a high level of referral and re-referrals to other services, long waiting times and too few completing therapy.

 

From the presentation the Committee were advised that there is significant evidence to support the need for change. A summary of prevalence among the 0-18 population in Newcastle and Gateshead was provided via a diagram illustrating that around 69k of the population are ‘coping’ through to just 69 able to manage risk.

 

It was noted that just under 1 in 10 children aged 5 to 16 will have some form of poor mental health with the most prevalent condition being emotional disorders. From the presentation an overview of the Gateshead Health Related Behaviour Survey (HRBS) was also provided noting that about a quarter of year 10 girls have high self-esteem compared with more than half of year 8 boys. It was further noted that families are the most popular source of support for both boys and girls but 1 in 10 said they didn’t know if they had an adult they could trust.

 

The Committee were provided with a chart of Gateshead CCG CYPS referrals from April 2017 to September 2018, CYPS waiting times for the same period and EWT referrals. An overview of waiting times for this period was also provided showing an increase in days of referral to treatment.

 

From the report a summary of Gateshead Kooth was provided. The Committee were advised that Kooth is an online counselling and emotional wellbeing platform for children and young people. It was noted that there have been 246 registrations since Kooth was launched with an average of 300 logins per month from Gateshead.

 

From the presentation the Committee were provided with information regarding the proposed changes to services. An overview of the Whole Systems Model was provided and illustrated via a chart within the report and presentation. The Committee were also provided with an overview of third sector service providers including Kalmer Counselling Services and Barnardo’s. The Committee were also provided with information on the THRIVE based service model illustrating the ‘prevention and promotion’ model and the ‘thriving’ model.

 

It was noted from the presentation that the way forward is for a single point of access for front door advice with assessment and treatment from the right service when it is needed. The Committee were advised that the single point of access model will ensure a better experience for referrers and provide timely interventions for children. It was also noted that having a single point of access will ensure a smoother journey for young people and their families and reduce waiting times.

 

It was acknowledged that not all things can change overnight but that progress has been made in developing the new transformation model. It was further noted that feedback from children, young people and their families has resulted in services being challenged to strengthen delivery upstream working towards an early intervention model.

 

The Committee were advised that the new model will cluster mental and emotional support for young people into four groupings:

 

·         Signposting, self-management and one-off intervention

·         Goal focused, evidence informed, and outcome focussed intervention

·         Extensive treatment and;

·         Risk Management and crisis response

 

An overview of local initiatives was also provided highlighting the work being done at Whickham School and others in addition to other web-based resources. Additional information was also provided on CYPS pathways noting the three pathways for assessment, intervention and treatment that can be followed by patients.

 

From the presentation the Committee were provided with details of the challenges that can be encountered in the rollout of services; these included multi-agency working, increasing awareness about children’s mental health, ensuring pathways are clear and managing demand for service users.

 

The Committee were then provided with information from the presentation on the mobilisation and implementation plan needed to provide the level of detail and assurance that would be expected within a response to an IITT. It was noted the plan should include a variety of potential sections including governance, specifications and engagement and communications.

 

A question was asked regarding pathways to services and the reduction of inpatient admissions. It was noted that due to improved triage, children and young people are being referred to the most appropriate service quicker than before.

 

It was highlighted that at a previous meeting information on the single point of access had been presented. It was noted that at the previous meeting the estimated figures presented were lower than the numbers being presented at this meeting. It was noted that there have been more referrals received than was previously estimated due to increased awareness of the new services. It was also noted that there are two main referral groups which are GP’s and education providers.

 

A query was raised regarding the increase in waiting times despite the new single point of access. It was stated that the increase is a result of new systems and processes being bedded in and that the figure is expected to decrease as time goes by. It was also noted that some services are still recruiting or restricting to better meet the needs of patients. It was highlighted that the figures seen between January 2019 and March 2019 will be the truest reflection of how successful the new service is working.

 

It was asked whether figures for Looked After Children were being collated to track the journey of those children and young people. It was noted that LAC are tracked and monitored from being referred to ensure that they are receiving the appropriate support whilst working with any relevant partner agency/local authority.

 

A discussion took place on patient tracking – it was stated that this is done on a weekly basis and tracking has shown that the figures for patients awaiting an initial appointment have decreased. It was further stated that many urgent referrals are seen the same day, quicker than the 72hr target. It was highlighted that there are increasing numbers for urgent referrals being received.

The Committee were advised that those awaiting an appointment are able to use services such as Kooth to bridge the gap before being assessed. A concern was raised noting that online services may not be appropriate for all, especially those who require face to face support. This was acknowledged noting that if a child or young person is seen to be in urgent need of support via an online platform then this information will be fed up to a higher tier so that interventions and support can be provided quicker.

 

Representatives from Gateshead Schools were present and provided their views and experiences of online services. The headteacher of Whickham School advised that the self-help tools available on apps/online can be beneficial. The Committee were advised that the top three issues being discussed via the online tools were relationships, depression and suicide. It was further noted that Whickham School have an in-house Councillor to support pupils.

 

A representative of Gateshead primary schools noted concern on the emotional development of children as a result of a lack positive interaction with their parents. It was noted that delays in emotional intelligence can be identified as a mental health issue when the real problem lies with attachment and social skills.

 

A comment was also made that third sector providers often struggle to meet the needs of children and young people in Counselling due to there being a limit of 6 sessions per patient. Further comment was made stating that it is too soon to say whether the new model presented will be a success – it was further noted that the report and presentation provided an optimistic view but not enough detail.

 

It was asked whether a child or young person being seen for self-harming would be refused access to service. It was noted that this would not be the case and that work would need to be done to identify the reasons the child or young person is self-harming. It was further noted that self-harming is not a ‘stand-alone’ mental health issue and is often a symptomatic response for something much deeper.

 

It was agreed that at a future meeting further detail will be provided on the services Strategic Plan in addition to details of the system complaints procedures.

 

RESOLVED:

(i)            The Committee received the report and agreed to receive further updates on the CAMHS transformation programme at a future meeting.

 

 

 

 

 

 

 

 

Supporting documents:

 

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