Agenda item

Joint Report

The Scrutiny Board considered a joint briefing note of the Council, Coventry and Rugby Clinical Commissioning Group (CRCCG), Coventry and Warwickshire Partnership Trust (CWPT), Coventry and Warwickshire Mind, and the Child and Adolescent Mental Health Service (CAMHS), which provided an update on CAMHS and the wider system, with a particular emphasis on how children were being supported in schools.

The note indicated that, nationally, the CAMHS system operated at four levels:

·  Universal Services (tier 1) – this included GP’s, primary care services, health visitors, school nurses, schools and early provision. 

·  Targeted Services (tier 2) – this included mental health professionals working singularly rather than as part of a multi-disciplinary mental health team.

·  Specialist Services (tier 3) – these were multi-disciplinary teams of mental health professionals providing a range of therapeutic interventions for children and young people with complex, severe or persistent mental health needs.

·  Highly Specialist Services (tier 4) – these included day and inpatient services and highly specialist services for children and young people with the most serious problems.  It could also include crisis or home treatment services which provide an alternative to hospital admission.

Appendix 1 of the note submitted showed the services that were delivered in Coventry, making up the CAMHS system locally.  It was particularly noted that tier 3 supported children aged from 0-18, was funded by the CRCCG and delivered by CWPT.  There were a range of other mental health services in the city, funded by both the Council and the CRCCG.  Coventry and Warwickshire Mind was another significant service provider.

Across the UK, child and adolescent mental health problems had been a significant concern for successive governments and it was recognised that problems could have a range of negative impacts on individuals and families which could continue into adult life.  Challenges included a significant increase in demand, which outweighed available capacity and resources. 

Since 2015, Government had increased NHS funding nationally to support mental health for children and young people through the CAMHS Transformation Fund.  A multi-agency CAMHS Transformation Board led by the CRCCG was established and a CAMHS Transformation Plan developed.  The Plan was designed to drive improvements across the CAMHS system locally and was refreshed and signed off annually by NHS England. 

The NHS 10 year plan was published in January 2019 and made reference to expanding children and young people’s mental health services and made a commitment to the following:

·  Improved early intervention / prevention

·  An increased digital offer

·  Mental health funding for children and young people would rise faster than overall funding

·  Mental health support embedded within schools and colleges, funded by central government from the Public Health Grant

·  Crisis and home treatment functions

·  Reduced waiting times for children and young people with Autistic Spectrum Disorder (ASD).

The Scrutiny Board noted that the local CAMHS Transformation Plan had made progress over the first three years in relation to the following:

·  Improved service responsiveness by CWPT specialist services

·  Implementing the new ASD pathway for school-aged children

·  The ongoing development of the Dimensions Tool, which provides an on-line resource to help parents and professionals gauge a child or young person’s emotional well-being and signpost them to appropriate help.

·  Delivery of support in schools, particularly through the enhanced Primary Mental Health Officer and positive outcomes this has achieved.

·  Launch of an integrated CAMHS Looked after Children (LAC) Service, with consultation and advice to social workers

·  Establishment and on-going development of the community eating disorders service and the implementation of access and treatment target timescales.

·  Sourcing additional clinical capacity via an independent provider to offset recruitment challenges.

·  Launch of a new website, plus utilisation of social media (Instagram, Facebook and Twitter)

·  Positive feedback from service users in many areas via the Experience of Service User Questionnaires, as well as feedback on CAMHS LAC and Primary Mental Health Services

·  Enhancement of the response for children and young people in crisis, including the creation and expansion of the Acute Liaison Team.

The note also set out the concerns in relation to the provision of service in Coventry.  The national picture was reflected locally, where there has been an increase in demand alongside difficulties in recruiting staff.  To date, during 2018/19 there had already been an increase in referrals to the tier 3 service of 66% compared with 2017/18.  It was estimated that this would rise to 81% by the end of the financial year.  Although the responsiveness of the specialist service had continued to improve, there was a concern about the ongoing waiting time for children and young people accessing services given the increased demand.  In addition, assessments for Autistic Spectrum Disorder (ASD) had increased by 23% to date during 2018/19 and, as there was a relatively limited availability of clinical capacity with diagnosing skills, children and young people were having to wait longer for an assessment.  

In terms of those areas that were working well, it was indicated that Education partners within Coventry had recognised that promoting good mental health and wellbeing in children from the earliest age required a whole system approach, of which CAMHS was one of many components.  There were examples of good practice across both the primary and secondary sector, with the following identified as common areas of practice:

·  The Thrive Approach

·  ACES (Adverse Child Experience Survey)

·  Primary Mental Health in Schools roll out

·  Specialist Services – Educational Psychology and the Social Emotional and Learning Team

·  School Partnerships

In addition, it was evident that schools invest significantly in internal pastoral support and specialist interventions, drawing on an increasing range of strategies and expertise.

The Scrutiny Board recognised the improvements that had been made and noted that work continued to further improve the service and the next steps proposed.  Further work was required to ensure that the interrelationships between the tiers was understood; to understand the capacity and demand gaps in service; to continue the work of the Primary Mental Health Team in up-skilling and building capacity in the wider workforce through training and consultation along with in-school training for staff on Mood, Attachment, Self-harm, and Eating Disorders and the training of facilitators for the Boomerang 5-week resilience course.  The roll out of the Dimensions Tool, including ongoing development and engagement work across key stakeholders needed to continue along with testing and evaluation work involving CWPT Internal Audit and the Warwick Business School.  In addition, work within the Education Service would focus on monitoring the Lancaster Survey for effectiveness and its impact on children, evaluating the ACES Survey and how this could inform secondary initiatives.

RESOLVED that, the Education and Children’s Services Scrutiny Board (2):

1.  Note the progress to date and endorses the plans to further progress the mental health and emotional wellbeing support available to children and young people living in Coventry.

2.  Request that a further progress report be submitted to the appropriate Scrutiny Board in 12 months time.