Minutes:
The Charman welcomed James Postgate, Associate Director – Integrated Commissioning, SEL ICB (Bromley) (“Associate Director”) and the LBB Director of Children's Social Care to the meeting to provide an update on children and young people’s mental health. A copy of the presentation is attached at Appendix A.
The Associate Director noted that Oxleas CAMHS, Bromley Y and LBB/ICB Commissioning had last presented an update to the Health and Wellbeing Board in June 2022. Board Members were advised that Children and Young People’s Mental Health and Wellbeing Services remained in a challenging situation, having seen a 25% increase in the number of children and young people in services since 2017-18. There had been a stark increase immediately after the COVID-19 pandemic with, initially, a 50% increase in the number of referrals into services. This had remained very high, although there had been a slight reduction in October/November 2022 – however it was highlighted that this was still not back to pre-pandemic levels. The Associate Director advised that children were presenting with more complex issues, which was having a big impact, and this was a picture being seen across the country. Waiting times for CAMHS remained high in Bromley, as in other areas of London, and there had been a need to find ways to support children and young people to better manage their own mental health challenges.
Bromley Council and NHS SEL ICB had now established a Bromley CYP Mental Health and Wellbeing Partnership Board to oversee transformation and improvements in these services. The membership of the Partnership Board included the Director of Children’s Services, the Director of Education, the ICB’s Place Based Director, Oxleas CAMHS and Bromley Y. The Partnership Board had agreed an improvement programme for CYP Mental Health and Wellbeing Services – they would look to shorten waiting times however the importance of implementing the right strategy was emphasised. The approach would be multifaceted and focus on prevention and early intervention. The Associate Director highlighted some key parts of the programme, which included:
- Integrated Single Point of Access for CYP MH and Wellbeing Services (Oxleas CAMHS/Bromley Y and other partners)
- Resilience and Recovery Programme (Bromley Y Lead)
- PCN Link Role (Bromley Y Lead)
- Bromley Eating Disorder Pilot (SLaM/Bromley Y)
- Empowering Parents, Empowering Communities (Bromley Y)
- Review of CYP ASD/ADHD Diagnostic and Support Pathway (LBB/ICB)
The LBB Director of Children's Social Care thanked the Board for ensuring that children’s issues remained on the collective agenda. It was highlighted that children and young people’s mental health remained a priority as there had been a significant uptick in the volume and complexity of presentations. Key areas of focus included:
- Early Identification/first responders and signposting in schools – mental health support teams in school were important as they saw vulnerable children more than any other professional. They could identify any emerging concerns and signpost children and young people to the right resources, for example the Bromley Eating Disorder Pilot.
- Exploration of shared front door – consideration was being given to taking this forward another step, and locating it within the Multi-agency Safeguarding Hub (MASH).
- Referral Pathways (avoiding duplication of referrals) – strengthening the way in which agencies communicated, saving time and consolidating a response. This would also provide a more consistent eligibility criteria.
- Working with families/parents (holistic approach) – any intervention was owned by all, and made it easier to action an intervention plan.
- Continue to engage ICB’s – to ensure that children’s issues remained high on the agenda. If issues could be resolved earlier for young people this would make inroads and impact for adults.
The Senior Clinical Lead said that the areas highlighted were recognised, particularly the complexity with which problems with families, and their relationships, had played out since the pandemic. GP surgeries could be a scary place for children and being able to tackle problems in places where children should be, such as schools, in coordination with other professionals, was important. Families could be frustrated by the pace at which things happened and it was vital that support was provided whilst they waited for other interventions to be put in place. Bringing co-ordination to ensure that things happened quickly and effectively was welcomed.
In response to questions, the Associate Director said that the Local Authority and ICB had a Mental Health and Wellbeing Strategy (2020-2025) and a budget had been set aside to support initiatives, including those for children and young people. The Bromley CYP Mental Health and Wellbeing Partnership Board had been established, and this was where businesses cases and proposals for initiatives were discussed. They had also benefitted from involvement in the Eating Disorder Pilot which had been funded by another organisation.
The LBB Director of Children's Social Care highlighted that the wider issues associated with mental health did not fit in a neat box as they permeated other services. Having a shared front door would bring people together to make links back into other departments or schools – they needed to have the right people working alongside each other and having trusted relationships. It was highlighted that just one referral should be made – it was then the responsibility of the officer to ensure the information was shared with the relevant departments/partners.
A Board Member said the proposed strategy was welcomed, particularly the single point of access. It was questioned if the current waiting times for ASD and ADHD were known. In relation to referral to treatment, the Associate Director advised that there had been an average waiting time of a year. The waiting times were now under a year for both ASD and ADHD, and it was agreed that the exact figures could be provided to Board Members following the meeting. The Associate Director said that there was always some level of waiting times and they were managed dynamically with those who were most in need placed at the top. There was integration between the NHS services and voluntary sector with clinical supervision which allowed referrals to other types of interventions while they waited for more specialist services. The ASD waiting list had been a particular challenge for some time and it was exciting to be able to bring in people to support this. They wanted to get the whole journey right, and the support services around it would be important.
The Bromley Place Executive Director said that the waiting times for CAMHS services were far longer than they would want to see, which was a national picture. The average waiting time for treatment was thought to be around 36 weeks – however there was a triage system in place, and those that needed treatment quickly would not wait that length of time. Those waiting longer would have continued contact with other services. There were workforce challenges, but they were trying to manage these with provider colleagues. The single point of access was considered to be a good initiative, but they would need to be clear about where children and young people wanted to go for treatment and assessment. They could not put all services together as this may discourage them from accessing them – there would be a joint approach to look at how different models might work.
In response to a question regarding the proposed Resilience and Recovery Programme, the Associate Director confirmed that if someone relapsed it would be flagged so they did not go back to the end of the queue to re-access services.
In response to questions, the LBB Director of Children's Social Care advised that the Mental Health Support Teams had been effective and were now embedded in schools. Schools understood the importance of early identification, as it was in everyone’s interest, and had been really engaged with the project. In terms of waiting lists, the LBB Director of Children's Social Care said it was clear that this was a national issue. When speaking with other Directors of Children's Social Care, from across London and the rest of the country, this was one of the top three issues and had been impacted by the pandemic.
The Chairman thanked the Associate Director and LBB Director of Children's Social Care for their presentation to the Board and requested that a further update be provided in the autumn.
RESOLVED that the updated be noted.