Agenda item

The Local Transformation Plan (LTP) is refreshed annually. The Health and Wellbeing Board is asked to note the Plan for 2019, which has been approved by NHS England and has been published on the Council’s and CCG’s website. This report also updates the Board on progress with embedding Medway’s Young People’s Wellbeing Service.

Discussion:

The Interim Programme Lead, Partnership Commissioning introduced the refreshed Medway Local Transformation Plan (LTP) for Young People’s Emotional Health and Wellbeing 2018/19, which was set out at Appendix A to the report. This updated Plan provided details on progress to date from commencement of the Plan in 2015.

The Board was advised that the LTP covered all aspects of children and young people’s emotional and mental health, with a focus on the transformation. Key to this transformation had been the recommissioning of the Child and Adolescent Mental Health Service (CAMHS) which was now provided by NELFT. The Board’s attention was drawn to the achievements and challenges of the new Medway Young Persons’ Wellbeing Service, as set out in section 3 of the report. In general, progress had been made improving the quality and management of the service. It was focussed on young people and aimed to ensure a system wide approach, with particular improvements being made in engaging with schools. It was noted that the Service was also IAPT compliant.

The Director of Children’s Services, NELFT, provided an update on the new Service. She set out the key areas of work following the implementation of the contract on 1 April 2018, these included:

·         creating a new Medway specific team by disaggregating a previously integrated team (across Medway and Swale) and incorporating Medway Council’s own Tier 2 (CAMHS) Service;

·         offering evidence based National Institute for Health and Care Excellence (NICE) concordant treatment;

·         developing and training the workforce to these standards;

·         developing care pathway models to deliver treatment;

·         verifying data to ensure that accurate performance can be measured and presented;

·         moving all staff to one electronic patient system; and

·         increasing contacts with patients, reducing waitlists and where appropriate discharging patients.

The Board was advised that the recently published NHS 10 Year Plan and Green Paper had set ambitious targets for children’s mental health. This included: providing support for schools by improving connections between them and mental health services, ensuring schools were better informed and supported in accessing the right services, including specialist services; reducing crisis presentations; and reducing the waiting time standard for children and young people referred for mental health treatment to four weeks. Future areas of focus were highlighted to the Board as set out in paragraph 3.3 of the report.

Members raised a number of questions, including:

Balancing delivering core clinical care and working within the system - With respect to a question concerning the workforce resource and whether technology had been considered to support practitioners in their work, the Board was advised that a number of innovations had been implemented, including:

·         Provision of a dedicated telephone consultation line, available to all local schools and social services, whereby qualified practitioners could be contacted if there was uncertainty about referring an individual. This service had received positive feedback from social care colleagues in that, very often, it had prevented the need for a referral through the provision of further guidance and advice.

·         Creation of a MindFresh App which provided a range of self-help tools aimed at children and young people. It was noted that this App was interoperable with electronic patient records.

·         It was also noted that NELFT’s Digital Strategist was also, currently, reviewing whether briefing videos, for example Mental Health First Aid could be provided to schools.

The Interim Programme Lead, Partnership Commissioning explained that there was a wide provision of support in Medway which was provided not only by NELFT but other external organisations, as well as, Medway Council’s Public Health Team. She undertook to provide Members with a briefing note on the support and services available.

Four-week waiting time standard for children and young people referred for mental health treatment -A Member expressed concern regarding this target and sought assurances that this was achievable. It was explained to the Board that within the NELFT contract the target was 18 weeks, this was a national standard. The four-week target was related to the national trailblazer (pilot) sites, which were not located in Medway. With respect to waiting times in Medway, overall, these had reduced and were close to 18 weeks, in line with the contract Key Performance Indicators (KPIs). However, it was explained that Medway was currently experiencing a very high level of referrals, some of which were very complex, which could increase waiting times.

ASD (Autism Spectrum Disorder) and ADHD - In relation to questions concerning sharing best practice and diagnosis and treatment, particularly in respect of neurodevelopmental conditions, the Board was advised that there was a need for further work to:  reduce waiting times; improve screening and diagnosis care pathways, which might include varying traditional care models; and support the education sector. More generally, it was explained to the Board that a system wide approach to managing neurodevelopmental demands was needed.

It was particularly important that NICE guidelines for the diagnosis and management of these conditions were implemented. The Director of People – Children and Adults Services advised the Board that a NICE compliant ASD pathway had been put place in Medway, in collaboration with NELFT and Medway Community Healthcare (MCH) as required following the recent SEND Ofsted inspection. This service supported children transitioning through the age spectrum to access the same pathway. It was noted that NELFT provided a specialist neurodevelopmental service which, in Kent and Medway, was experiencing high rates of referral. In the first 8 months of the contract, NELFT had secured additional resources which had reduced the number of individuals on the waitlist by circa. 500 individuals.

Engagement of schools - With reference to paragraph 2.6 of the report, a Member asked whether schools could be challenged with regards to the level and consistency of support, including counselling, they provide to their pupils. In response, it was recognised that there was a lot of variation within schools on the breadth and quality of support provided. The Board was advised that the Public Health Team in conjunction with NELFT had liaised, and would continue to liaise, with schools to determine how best they could support them to commission the best interventions for pupils. The Public Health Team had shared good practice and held conferences and workshops on child health, with a view to support schools further. It was noted that schools did not have the resources to undertake the necessary needs analysis but it was considered that following evaluation of the trailblazer sites, the results would help to demonstrate what interventions had worked best at schools and therefore, this would help other schools determine where to focus their investment. In addition, the Public Health Team and NELFT could utilise population level data, including SEN registers as a proxy to suggest interventions which were likely to be effective. A view was expressed that all Medway schools should be challenged to provide high quality support for their pupils. Clarification was sought on what influence, if any, NELFT could have in this regard and a request was made for a briefing note to provide an update on what actions could be taken to ensure a coordinated approach to achieve this objective.

Decision:

The Health and Wellbeing Board:

a)    noted Medway’s LTP for 2018/19 and the wider update on embedding the Medway Young Persons’ Wellbeing Service.

b)    requested a briefing note on:

                      i.        services available to support children and young people’s emotional and mental health; and

                    ii.        actions which could be taken to challenge schools to ensure they provide high quality support for their pupils.