Agenda item

The Board considered a presentation from the Associate Director of Integrated Commissioning, Bromley CCG providing an update on Bromley Children and Young People’s Mental Health and Wellbeing Services, towards a refreshed transformation plan 2020/21.

Bromley Council (LBB) and NHS Bromley CCG (BCCG) commissioned a range of services to support the mental health and wellbeing of children and young people in the Borough. Whilst there were a range of different services in the area, the core mental health and wellbeing offer centred on the provision of the Wellbeing Service for Children and Young People (Bromley Y) and Children and Adolescent Mental Health Services – CAMHS (Oxleas NHS Foundation Trust). The dual service model was originally established in 2014/15, since which a strong joint working partnership had been developed between the two services.

The NHS Long Term Plan had a target to increase access to children and young people’s mental health and wellbeing services. The South-East London Sustainability and Transformation Partnership (STP) had been monitoring this target across the six boroughs of south-east London. Bromley had consistently out-performed its neighbours, with the NHS / Voluntary and Community sectors (VCS) model at the heart of the area’s success in meeting this target. However there were some significant challenges, including the year on year increase (since 2013/4) in the number of mental health emergency presentations at Accident and Emergency (A+E). A Member noted that over a third of the emergency presentations at A+E had ‘parental health issues’ listed as a factor, and asked if details of the types of issues this referred to were known. The Associate Director of Integrated Commissioning advised that work on “deep dives” was currently being undertaken to analyse this, and an update could be provided to the Board once completed.

In response to a question, the Associate Director of Integrated Commissioning advised that early indications showed that the children and young people presenting at A+E were not known previously by CAMHS, Wellbeing services or GPs. In terms of outreach, it was noted that schools could play a major role and support was needed to help them identify issues earlier.

In seeking to put in place the right future model for children and young people’s mental health and wellbeing services, supported was provided by a “deep dive” Joint Strategic Needs Assessment (JSNA) project into this area in 2018. The results of this analysis showed an increase in the number of young people being seen by CAMHS services in Bromley, and the highest numbers of issues were identified as relating to ‘home’ and ‘school’. It was noted that this would also be an area that would be looked at in more depth via a “deep dive”.

Since 2015, all NHS CCGs in England had been required by NHS England to have an agreed annual local CAMHS transformation plan. Since these plans were first put in place, Bromley CCG had worked closely with LBB to develop joint plans, which had been informed by the work of the Health and Wellbeing Board. Bromley’s joint CAMHS transformation plans had been particularly well-received nationally. Last year’s plan was accredited as “green” by the National Society for the Prevention of Cruelty to Children (NSPCC), meaning the plan “made explicit use of data from service provision and the Joint Strategic Needs Assessment (JSNA) about children and young people vulnerable to mental health problems and also uses data to assess local need and inform service provision”.

The 2020/21 plan was currently in development, with engagement taking place across LBB and the CCG, as well as with providers, children, young people and families. The development of the draft 2020/21 CAMHS transformation plan refresh built on the outcomes of the Bromley Children and Young People’s Joint Strategic Needs Assessment (JSNA) in 2018. The plan also highlighted a number of key projects to improve children and young people’s mental health and wellbeing in Bromley. These included the Bromley Wellbeing/CAMHS Integration and Four Week Wait Pilot; Wellbeing in Schools; the CAMHS in-reach into children’s social care and the Youth Offending Service; and a digital offer and online counselling (Kooth.com).

It was noted that the delivery of short waiting times into specialist CAMHS was a challenge across England. Bromley had been successful in receiving funding from NHS England/Improvement to pilot new ways of working to transform the CAMHS provision, with shorter waiting times and an improvement in outcomes for children and young people. In Bromley, the delivery of the Bromley Wellbeing/CAMHS Integration and Four Week Wait Pilot had been identified in relation to the further integration of the NHS/voluntary sector delivery model, with improved joint working across the entire pathway of services and clinical input into the Single Point of Access (SPA). The LBB and CCG had agreed to put in place a new joint service model for the Wellbeing Service by March 2021, ending the situation where they both commissioned this service separately.

Bromley was one of twelve areas successfully chosen as a ‘Wave 1’ area for the Government’s Transforming Children and Young People’s Mental Health Programme. The Wellbeing in Schools service pilot scheme had been rolled out to half the schools in Bromley, providing a tailored offer of mental health and wellbeing support. The first batch of data from the scheme would be analysed with the Director of Education the following week. It was noted that the other Bromley schools not involved in the pilot were linked up with other services within CAMHS. In 2019, Bromley were also invited to take part in the national Department for Education/Anna Freud Centre Mental Health Schools Link Programme. This would see two programmes held in the Borough during May and June 2020.

A key priority for LBB and the CCG was to improve joint working between children’s social care and children and young people’s mental health and wellbeing services. It was recognised that many of the children and young people being supported by services required input from both social care and CAMHS. There was ongoing work to develop an “in-reach” service for CAMHS into children’s social care. Early support had been extended to social care teams, with CAMHS practitioners leading workshops with social work teams to help them better recognise mental health problems. It was noted that there was a strong health offer into the Youth Offending Service (YOS), including an embedded CAMHS clinician. This enabled strong joint working between CAMHS and YOS caseworkers. The CCG also funded a “liaison and diversion” post in the YOS, who worked with Bromley Wellbeing and other services, to look at ensuring there was the right community and wellbeing support for children and young people in the YOS.

All CCGs in south east London had commissioned a fourteen-month ‘online counselling’ pilot, “Kooth.com” which was provided by Xenzone. This was an online service which offered counselling to young people (aged 10-19, and up to 25 where there was an additional need). Young people were involved in the co-production of this digital site and there was a clear view that there were strengths to this model. Bromley was seeing a consistently higher use of Kooth services than any of the other CCGs in south east London. The reasons for this would be explored as part of the next steps for the service. The six CCGs had agreed to extend the pilot, with a consistent offer up to age 25, and a greater focus on Children Looked After (CLA) as a group at higher risk. In response to a question, the Associate Director of Integrated Commissioning said that as well as CLAs, they also recognised the increase in the number of children with Special Guardianship Orders (SGO). Initial conversations would be taking place with Children’s Social Care in relation to how these children could be supported.

The next steps planned in relation to Bromley Children and Young People’s Mental Health and Wellbeing Services included:

-  ongoing engagement on the CAMHS transformation plan, with NHS assurance work on a joint plan;

-  CAMHS transformation steering groups would take place in February and March 2020 to receive updates on the four week wait and Wellbeing in Schools pilots;

-  ongoing work to develop an in-reach model from CAMHS into children’s social care; and,

-  ongoing monitoring of levels of emergency admissions of Bromley children and young people.

A Member noted that Bromley Y and CAMHS used different IT systems, and asked if there was any investment planned to upgrade them. The Associate Director of Integrated Commissioning responded that improved IT was planned across Bromley Y and CAMHS. It had been specified that the two teams needed to work together, and a data sharing agreement would be in place.

A Member highlighted that the highest suicide rates were related to young men, and asked if interventions were being made available to this group early enough. The Associate Director of Integrated Commissioning responded that they could improve on how they reached out to young men, and work to address this was in progress. A thorough plan was being put together, they were talking to providers, and some pilot schemes were already in place. The Director of Education said that there had been an increase in the universal and targeted offer through schools, and the national Department for Education/Anna Freud Centre Mental Health Schools Link Programme. It was hoped that in the future, the Wellbeing in Schools service could be extended across all schools. The Director for Public Health advised Members that a report on the overall pathway for adult and children’s mental health prevention would be presented to the Board later in the year.

Members noted that the report highlighted a definite trajectory of improvement, which was attributed to the CAMHS professionals on the front line. This was making a huge difference to the lives of children and young people at a difficult time, and thanks were extended to all those involved in this work.

RESOLVED that the report be noted.