Agenda item

This paper summarises the Children and Young People’s Mental Health transition arrangements currently in place as well as planned development areas.

Discussion:

Members considered a paper which summarised the Children and Young People’s Mental Health transition arrangements currently in place as well as planned development areas.

As the Committee was the lead on scrutiny of health in cases of the transition between childhood and adulthood, representatives of the Children and Young People Overview and Scrutiny Committee were present to participate in this item. In addition, the Committee considered written representations from the Medway Parents and Carers Forum representative on the Children and Young People Overview and Scrutiny Committee, who made the following points:

·         many parents/carers found that support was good until the transition point and very often the young person did not meet the adult criteria, leaving them with nothing.

·         parents then became frustrated and the young person’s mental health quickly deteriorated, needing more support than perhaps they would have.

·         mental ill health was higher in ages 16-24 because transition was so poor.

·         it could be difficult to differentiate the CCG plans for Medway and Kent

·         Kent being the larger area received more support than Medway

·         It was good that the LTP mapping of services had been completed but whether there were companies duplicating work was queried.

·         the need to signpost parents and young people to service was critical.

·         the Forum was about to launch a Health Survey which would include learning disability health checks and opinions on all health services in Medway. An offer was made to analyse the 18-25 age group and report back to the Committee.

In discussing the paper, several Members expressed their concern that transition services had not improved in spite of long standing, severe problems in children’s mental health services. 82% of the young people spoken to in Medway had said they had experienced difficulties with emotional wellbeing or mental health in the past and had sought help from or accessed help. In total 1 in 3 young people from Medway were currently accessing mental health support from a service. There was a very confused landscape of providers, a recruitment crisis and demand was at an unprecedented high.

The lack of a plan to improve services with milestones and data was criticised, as was whether there would be any progress under the new Integrated Care System and how this would be monitored.

The point was made that there was a constant cycle of intensive treatment, help from community services and then patients having to describe from the beginning their problems at the next crisis.

The lack of a robust service at the acute hospital for mental health patients who had gone there having found nowhere else to get help was referred to.

An assurance was sought on how the period before, during and after transition would be managed with a plea for this to be seen not as separate sections.

A point was made that intervention did not happen until a person’s condition had significantly worsened. If early intervention took place this would minimise people facing a lifelong recurring need for social care.  Members were advised that the approach that of an understanding a graduated response to services and young people’s needs, with a focus on early interventions. As part of that approach GPs were being trained on how to support families to navigate around services. For people suspected or diagnosed with a neuro-development condition there was community support team which worked with families.

In response, officers accepted there was more to do but felt the report showed a positive position in terms of moving the agenda forwards, noting this was an NHS programme which the Council was working to shape. Members were assured that officers championed Medway in discussions involving Kent and Medway.

Members were advised that there was a crisis and complex pathway which would hopefully address some of their concerns. The latter involved in a closer working relationship existed with the acute hospital, matrons in the hospital working with young people to assist with transition and an expansion of the crisis team to support young people up to two weeks post episode. Emotional Support Teams were working with the North East London Foundation Trust (NELFT) in 33 schools in Medway to look for early identification of behaviours and this would be rolled out in all schools. Therapeutic support for people on the social care register, but who were below the CAHMS threshold, was now offered.

The CCG representative advised strategies were in place which would mitigate many of the concerns expressed by Members. For pre-transition young people there was a locality team run by NELFT for young people with mental health needs and KMPT supported young people post transition. There was a gap here so a strategy had been put in place where NELFT and the Kent and Medway NHS and Social Care Partnership Trust (KMPT) worked together with adult social care to discuss young peoples’ needs when they reached 17. Post transition, there was increased support for the 18-25 period. New staff had been recruited to help with the workforce challenges.

In response, the point was made that NELFT had assured the Committee that they were not overwhelmed when Members’ experience showed schools were not coping with the high numbers of young people with mental health needs, the causes of which were varied and increasing. Members were advised that NELFT were one part of system and all the partners involved had a role to play.

An update was given on the recruitment plans outlined in the Local Transformation Plan (LTP) and also the commitment to increase the number of inpatient beds at the Kent and Medway Adolescent Hospital by an additional six beds by the end of 2021. The 6 inpatient beds were on track to open in the summer. One of the beds was for Medway.

The Director of Public Health acknowledged it would be a challenge to address these issues, which the pandemic had exacerbated. There were positives in the report, which also highlighted the problems and challenges. In terms of measuring progress, the Council would be a part of the Integrated Care Board and the Integrated Care Partnership. The latter would develop an Integrated Care Strategy and mental health would be a key priority. Periodic updates could be provided to the Committee.

In response to a query about staff training, the training programme would be shared with Members.

Decision:

The Committee agreed to:

a)    note the developments to date.

b)    request a paper on the crisis and complex pathway programme.

c)    note the offer to provide an update to the Children and Young People Overview and Scrutiny Committee.

d)    request further details on the accountability arrangements for services.