This report provides an update to Health and Wellbeing Board concerning the mobilisation of the Medway Young Persons’ Wellbeing Service which NELFT will be providing in Medway from 1 September 2017.
The report also describes the timetable for implementation of the new service and delivery model.
In line with national assurance requirements from NHS England, a refreshed Local Transformation Plan for Children and Young People’s Mental Health and Wellbeing is provided in Appendix 1 for review and consideration by Health and Wellbeing Board.
Nationally, Health and Wellbeing Boards are required to have oversight of Local Transformation Plans and to offer endorsement, prior to their publication and submission to NHS England.
The Programme Lead – Targeted Services,Children’s 0-25 Commissioning Team introduced the report. Extensive consultation and market engagement work had been completed in relation to the proposed service model for the new Medway Young Person’s Wellbeing Service. Procurement had been completed in April 2017 with the contract having been awarded to NELFT (Formerly North East London NHS Foundation Trust). Following a four month mobilisation period, NELFT had become the service provider on 1 September. The new service would be locally accountable but would also benefit from strategic links to Kent, with NELFT also providing the Kent Children and Young People’s Mental Health Service and the Kent and Medway all-age Eating Disorder Service.
The Consultant Clinical Psychologist from NELFT introduced a presentation on the Medway Young Persons’ Wellbeing Service (YPWS), the key points of which were as follows:
· Historically there had been a clear division between Tier 2 and Tier 3 CAMHS provision with local authorities tending to provide Tier 2 services and the NHS being responsible for Tier 3 provision. This meant that service provision was not always joined up. The aim was to provide a single service, as had been successfully undertaken in Essex.
· Tier 3 CAMHS services were for the more severe and enduring mental health issues, while Tier 2 provision was for less serious cases that tended to be related to emotional wellbeing.
· It was recognised that the CAMHS workforce needed further development and that recruitment was difficult. There was also a need to better connect mental and physical health services and to improve access to emotional health and wellbeing services.
· A staff consultation was currently being undertaken with staff transferring from previous providers.
· All staff had been given a 4g enabled laptop and a mobile to enable them to work from any location.
· The service aimed to enable young people to be seen as close to home as possible.
· NELFT was keen to engage with young people. Youth ambassadors had been recruited in other areas with a similar approach being planned for Medway. Engagement with schools was also important.
· Work was being undertaken to provide services digitally. This included NELFT working with Big White Wall, an online only provider of mental health services. A young person’s mental health app had been developed to signpost young people to appropriate sources of help. The use of social media was also becoming increasingly important. ‘Mylife’ workshop sessions with schools could be filmed and digitised for use by other young people.
· CAMHS provision did not receive enough funding at national level to enable needs to fully met using traditional service delivery models. Therefore, services would need to be delivered using different methods.
· The Children and Young People's Improving Access to Psychological Therapies programme (CYP IAPT) was a national programme to improve access to psychological therapies. A number of related training courses were available in London which staff in Medway would be able to benefit from.
· Having a five year contract for service delivery would enable NELFT to fully embed and sustain improved service improvement.
The Board raised a number of points and questions as follows:
Ease of access to services – A Board Member considered that it was particularly important for mental health patients to be treated as close to home as possible and that the threshold for CAMHS provision needed to be low enough to enable them to get the support they need. Representatives from NELFT said that work was being undertaken through the national New Models of Care programme to consider how inpatient services could be provided closer to a child’s home. It was anticipated that some changes would be realised in 2018 and NELFT were already participating in shadow form, prior to fuller involvement when the Kent and Medway services were fully established.
Support for Schools – Members asked what support was available for schools and what engagement was planned with schools and young people, including the Children in Care Council and Medway Youth Council. Officers advised that support was commissioned in schools but that work was not always as co-ordinated as it could be. The increasing number of schools becoming academies was a challenge as the local authority had less direct influence on how these schools operated and dealt with mental health issues. Better collaborative working was required at both primary and secondary level. Working with headteacher executive groups was seen as a way of improving collaborative working as well as providing schools with access to clinical supervision and complex case training.
Support for Clinicians – A meeting attendee asked whether there was scope to develop the support available for clinicians in relation to child mental health issues. The NELFT representatives said that the main function of the Young Person’s Wellbeing Service was to deliver services directly but the opportunity to help upskill clinicians to complement this work would be welcome. This would be discussed further outside the meeting.
STP alignment - The Director of Public Health emphasised the need for the Wellbeing Service to be aligned to the development of the Kent and Medway Sustainability and Transformation Programme and also to 0-19 child health services procurement and work in relation to social isolation.
Appointment timescales – A Member asked what the specified timescales would be for a service user to receive an initial appointment. It was confirmed that current timescale for patients to be seen was within 18 weeks for non-urgent cases, which was acknowledged to be too long. It was recognised that some people remained as service users for a longer period than necessary. It was anticipated that better considering the goals of each child and their family could help to reduce the length of time that some children remained in the service. This would in turn help to reduce waiting times.
Work was taking place to review current waiting lists, staff capacity and clients’ needs to consider whether temporary staff were needed ahead of permanent recruitment being undertaken. Permanent recruitment would commence following an internal staff consultation which was due to take three months.
A single point of access to the service had been created with immediate phone advice available. A clinician would review the case upon receipt of the call to make a judgement as to whether there was a need for an appointment with the crisis team. This could typically be arranged within hours.
Health provision in schools – A Member questioned whether schools should have a specific staff member dedicated to health and wellbeing who would act as a single point of contact. The NELFT representatives agreed that this could be beneficial and advised that schools they were working with in Essex had identified an emotional wellbeing champion. Relevant school staff were also able to contact key individuals at NELFT to obtain advice directly. The Director of Public Health added that a dedicated school health team covering Medway was already in place.
Counselling provision in schools – In response to Board Member concerns that schools may stop employing their own counsellors as a result of the provision of the Young Person’s’ Wellbeing Service, the NELFT representatives had not seen evidence of this. Any reduction in counselling provision was likely to be due to general budgetary pressures.
i) Noted the report and the significant progress made in relation to the procurement and mobilisation of the Medway Young Persons’ Wellbeing Service.
ii) Provided comment and feedback on the refreshed Local Transformation Plan for Children and Young People’s Mental Health and Wellbeing, prior to publication and submission to NHS England for assurance purposes.
iii) Agreed that NELFT be invited to present a progress update to the April 2018 meeting.