Agenda item

Report CSD22071

The Board considered a report providing an update on Children and Young People’s Mental Health. The Charman welcomed James Postgate, Associate Director – Integrated Commissioning, NHS South East London CCG (Bromley) (“Associate Director”), Yvonne Onyeka, Team Leader – Bromley Y (“Team Leader”), Rebecca Wheatcroft, Consultant Clinical Psychologist – Oxleas NHS Foundation Trust (Bromley CAMHS) (“Consultant Clinical Psychologist”) and Laura Craggs, Operations Manager – Oxleas NHS Foundation Trust (Bromley CAMHS) (“Operations Manager”) to the meeting.

The Associate Director informed Board Members that Bromley Council and NHS South East London Clinical Commissioning Group (CCG) – Bromley 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:

(a)  the Wellbeing Service for Children and Young People (Bromley Y); and,

(b)   Children and Adolescent Mental Health Services – CAMHS (NHS Oxleas Foundation Trust).

The dual service model was originally established in 2014/15. Since then there had been strong partnership working between the two services which were strengthened in April 2021 when the Council and CCG jointly awarded Bromley Y a new integrated contract to provide mental health and wellbeing services for children and young people in the borough.

The impact of the COVID-19 pandemic had been seismic across all groups. That said, for children and young people, who had experienced lockdowns and school closures, this had been a particularly challenging period. The impact had seen, since September 2020, a significant rise in referrals to both Bromley Y and NHS Oxleas CAMHS, notably:

-  a 47% increase in referrals to the joint NHS Oxleas CAMHS/Bromley Y single point of access (SPA) since September 2020;

-  a 16.8% increase in routine referrals to NHS Bromley CAMHS;

-  an increase in the clinical complexity of referrals resulting in an increase in contacts per case; and,

-  a 15.7% increase in emergency presentations to NHS Bromley CAMHS.

NHS Oxleas CAMHS and Bromley Y reported that, of the higher numbers of children and young people accessing the services, more were likely to have complex and multi-faceted challenges than was typical prior to the pandemic. That meant that more children and young people were staying with services for longer, increasing caseloads overall. The Associate Director said that it was important to note, however, that the current situation with children and young people’s mental health and wellbeing services was a national picture and that Bromley’s services had coped well in difficult circumstances.

In light of the current situation in services, the Council/CCG with Bromley Y and NHS Oxleas CAMHS had come together to develop proposals to meet the current challenges across service lines. The different organisations had agreed a number of priority areas to focus on in the first instance, as set out below:

·  joint leadership/communication across children and young people’s mental health and wellbeing services in Bromley.

·  the development of an integrated solution for children and young people who required support at a higher level than was provided by Bromley Y but who were not currently receiving treatment from CAMHS.

·  the development of an integrated solution for children and young people currently under CAMHS who were unable to move out of the service due to a need for additional step-down provision.

·  the development of an integrated solution to improve partnership working with children’s social care in relation to children and young people with both mental health and social care needs.

·  the development of improved ways of working between children and young people’s mental health and wellbeing services for children and young people with more complex and multi-faceted needs.

A Member noted that they were pleased to hear that waiting lists of those not able to be seen immediately were being monitored to assess risk, and enquired as to how the risk between the two services was managed. The Team Leader said that lots of discussions were taking place in relation to bridging the gap between the two services. They were looking at creative ways, including putting training in place, with the aim of reducing the number of young people going to up to CAMHS. The Operations Manager said that they had been focussing on the cohort that did not quite meet the level of severity to access CAMHS and discussed managing the risk collaboratively and utilising the Thrive model. In the interim, joint triage and joint consultation would result in support being provided by both services.

Another Member noted that the waiting lists were a concern for GPs and improved conversations were required regarding initial assessments. GPs needed to be educated in terms of the resources available and supported with information to signpost young people and their families. The Consultant Clinical Psychologist provided reassurance that children and young people were on a ‘managed waiting list’ and always had an allocated professional, such as a SENCO or social worker, who would support them and advocate on their behalf during this time to ensure that access to CAMHS was prioritised when needed. In response to a further question, the Consultant Clinical Psychologist said that children and young people were presenting with more complex emotional and mental health issues. Many were in conjunction with other issues, such as safeguarding, neglect, or exploitation, which added an additional layer of complexity.

Jonathan Lofthouse, Site Chief Executive – PRUH and South Sites, King’s College Hospital NHS Foundation Trust informed Members that the PRUH had been a frontal point for those in most extreme crisis and the timeliness of management had been complex. It was not unusual for a child to be in crisis at A+E for multiple days, and this was not the appropriate place for them to be cared for – it was one place of safety, but there were others available. It was highlighted that, UK-wide, the provision of acute services for children and young people were severely stretched. The Chairman enquired if more work would be undertaken in relation to preventative aspects. The Consultant Clinical Psychologist said that this was an ongoing workstream – it was included in the action plan and meetings were held at least monthly. At a recent meeting there had been a presentation in relation to supporting schools to identify and assess children’s mental health and information was provided on websites that could be regularly accessed. Mental Health and Wellbeing leads had been established in all Bromley schools, for which a job description and training had been provided. The member of staff who took on this role was decided by the school itself – some were Headteachers, Deputy Headteachers or Pastoral Care leads and the Department of Education (DfE) had been championing for higher level staff to take on this role. It was noted that all schools had also completed a diagnostic test through the Anna Freud Centre which indicated how mental health and wellbeing ready they were.

In response to questions, the Team Leader advised that Bromley Y provided support to schools, additional guidance and referral pathways. Some schools requested additional 1-2-1 support, whilst others had their own counselling service – therefore different models for schools were available and could be negotiated. The service with some schools had been discontinued due to staff leaving, and discussions had taken place regarding how to reinstate the service. They had tried to recruit staff of the level and quality required; however it was regrettable that they had been unable to. It was emphasised that they had not pulled out of any school where they had not needed to. The Associate Director noted that some schools funding had stopped and therefore Bromley Y was running at a loss and a refresh of the service would allow them to provide what was needed.

A Member highlighted the comments made in relation to recruitment struggles and asked if the rates of pay for counsellors contributed to this issue. The Team Leader said that it may do for some, but they also provided training and support which would not be given in a private appointment. They were good at retaining staff, and many had been there a long time, but it was a challenge as they were operating at a loss – yet they often received push back from schools who considered it to be an expensive service. In response to a question from another Member, the Team Leader said that it was a competitive market and as Bromley Y was a charity it put resources into frontline staff. Candidates put themselves forward for the vacant roles, however they were not always of the level required. During lockdown, many people had needed to stop carrying out their volunteering roles – they had kept rounds of recruitment going, but it had been challenging. Going forward they were looking at how things could best be configured, including expressions of interest and recruit to train posts. The Consultant Clinical Psychologist said that recruitment was a problem nationally – increasing mental health needs had led to staff burnout, and increased acuity resulted in patients not getting better as quickly as they would like them to. The impact of parental mental health, particularly parents of school aged children, had been at the forefront of the queries received. New training would be created including two new disciplines, occupational therapy and social workers, who would provide support with evidence-based training.

The Chairman noted the reference made in the report to seven secondary schools being identified as likely to benefit from additional targeted support. The Consultant Clinical Psychologist said that these were schools that had higher numbers of pupils presenting at A+E and they would look to understand what the issues might be. It was highlighted that there was no direct correlation between the schools, and that they could change over time. The Director of Children’s Social Care noted that the commissioning process had set the financing of the service and budget implications of additional funding would need to be considered. The Director of Children’s Social Care said he would be happy to be involved in conversations with Bromley Y with regards to making commissioning as effective as possible – there was “no quick fix” and they needed to ensure they had the best team of people possible. In response to a further question from the Chairman, the Associate Director said that the Safeguarding Partnership had agreed to provide data analysis and monitor peaks in relation to emerging trends, themes and patterns of concern.

In response to questions from a Member, the Consultant Clinical Psychologist said that she attended the Suicide Prevention Steering Group, and one of its subgroups. With regards to those known to CAMHS, the data in Bromley for the number of suicide deaths was lower than other London boroughs, but this was something that would continue to be monitored. It was noted that the number of attempted suicides was an increasing profile nationally and there had also been a huge increase in incidents of self-harm.

A Member asked for further information in relation to waiting times. The Associate Director said that in April 2022 the average waiting time for CAMHS had been 24-weeks, compared to 17-weeks in 2019/20. However there was some variation for different groups with crisis cases (4-weeks) and neuro-disabilities (32-weeks). It was agreed that information on waiting times could be circulated to Board Members following the meeting.

In response to questions, the Team Leader said that in terms of signposting, during the initial contact meeting consideration was given regarding where support could be accessed. Services such as Kooth, an online mental wellbeing community, was well used and a text-based support service had been established to signpost people to webinars and packages which were endorsed by the NHS. In relation to the wait for services, they had a navigator role – this person could be contacted if things escalated whilst a patient was waiting to access services and would ensure that a package of early intervention care was put in place. It was considered that social prescribing would also play a part going forward to ensure that people kept active and/or felt less isolated. The Consultant Clinical Psychologist said that other boroughs had introduced individual support plans for those presenting with mental health needs, and she had discussed the possibility of setting these up with the Operations Manager. It was noted that they often referenced the Bromley Y webinars and highlighted ones which would be beneficial for children and parents to view. With regards to the Local Authority, the Consultant Clinical Psychologist said they would like it to maintain its compassionate stance. Staff had faced the biggest challenge seen for many years – they were working as hard as they could but it was highlighted that there were limitations. These comments were echoed by the Operations Manager, and the need for integrated working and early intervention was emphasised.

The Chairman thanked the Associate Director, Team Leader, Consultant Clinical Psychologist and Operations Manager for their update to the Board. It was noted that the information from the deep dive had been extremely helpful, and a further report was requested at the end of the calendar year.

RESOLVED that the current issues in Bromley children and young people’s mental health and wellbeing services, and a proposed way forward, be noted.