Agenda item

Beki McAlister, Strategic Commissioning Manager, CYPS to present

Beki McAlister, Strategic Commissioning Manager, Children and Young People’s Services (CYPS), presented a progress report.  Anders Cox and Barbara Murray from RDaSH, Ruth Fletcher-Brown, Public Health, and Susan Claydon, Early Help CYPS, provided additional information.

The report provided an update against the recommendations from the Scrutiny Review of Child and Adolescent Mental Health Services (CAMHS) in December 2015.  The principal focus of the review had been RDaSH CAMHS, however, the review acknowledged that these services were not provided in isolation but were part of a complex system of service commissioning and provision.  The 6 themes included in the update impact on the wider system and had been previously agreed by the Commission as the focus for future updates.

Mental Health was high on the national agenda with a Green Paper due imminently on young people’s mental health and particularly looking at early intervention approaches, working around in schools, the community and workplaces.  Locally, there had been a transformation of CAMHS and the new Section 75 Agreement pooling budgets between RMBC and the CCG had significantly changed commissioning arrangements.

·           Impact of the CAMHS Single Point of Access – The CAMHS Single Point of Access (SPA) was now well established.  Integration with the Early Help Single Point of Access was agreed in 2016 and began a pilot phase in 2017, however there was a delay in progressing this work due to changes to management within CAMHS.  The Single Point of Access had now been revisited alongside Early Help and the work was progressing positively. Strategic discussions were underway to enhance integrated working with the Early Help Single Point of Access.

       The CAMHS SPA was the main access point alongside contact through the locality workers.  There was closer working with services that worked closely with young people and in-reach to the Early Help SPA.  More dialogue was taking place on referrals coming in to ensure the right help and more timely help with young people not being “bounced” around the system as it had been viewed historically.

·           Impact of CAMHS Locality Working – there was now an established and active presence in local communities.  Feedback was now regularly sought to evaluate and improve the locality approach.

This linked in with the presentations on the Whole School Project with locality workers working with secondary schools and some of the primaries, which was helping to support teachers to be more confident in dealing with mental health and identifying need.    RDaSH also supported World Mental Health Day and #HelloYellow.  Locality staff had worked with GPs to raise awareness and were increasingly seeing people in community settings as well as at Kimberworth Place.

·              Training and Development for the wider CAMHS workforce – Strategic links were being made within RMBC and pilot work had commenced with the Yorkshire & Humber Clinical Network around a competency framework for school based staff.

         The Yorkshire and Humber Framework “In It Together” considered what training the different staff groups needed and at what level. They had looked at Early Years settings, primary and secondary schools and also colleges.  Wales High School was piloting the Framework and involved from the outset.  Schools would be able to self-assess against the competencies staff should have with the Framework also providing guidance about training and where to access it.  A mapping exercise of training across the CAMHS partnership has been carried out to understand what was currently being provided.  Top Tips documents (universal workers and for GPs) would be renewed at the end of the year.  Safe Talk Suicide Prevention courses had been running and had had a good take up.  RDaSH training for schools by the locality workers had been well received. 

·              Performance Monitoring and Outcomes – Rotherham Clinical Commissioning Group (CCG) was undertaking an annual baseline data collection to inform the October refresh of the Local Transformation Plan (LTP) and feed into the Joint Strategic Needs Assessment (JSNA).  RDaSH were implementing a new electronic records system that would improve reporting against outcomes.

 
A CAMHS Section 75 Agreement would commence from 1st November 2017.  The Agreement between RMBC and the CCG would strengthen joint performance management and measurement of outcomes linked to the delivery of the LTP.

It was a very complex picture on provision and commissioning and lack of data was recognised as a national problem with regard to identifying children’s mental health needs.  Annual baseline data was collected by the CCG as part of the LTP.  It had proved difficult to implement the Framework as partners either did not have that type of information or it was not readily available.  Over the next few months Beki was intending to meet with all providers to ascertain what information they held, what could be shared and to put something more light touch in place in terms of data gathering.  It would be a more collaborative approach as well as a need for a different approach to get data from schools given the number and the offer so that it was not overly burdensome.  The CAMHS/schools interface meetings might be the place to start those discussions and then to build a local picture to feed into the JSNA.

Regarding outcome measures, RDaSH collected data on a very individual basis but faced with IT difficulties were unable to present a whole team picture.  There would be movement over to the new IT system mentioned earlier, with CAMHS one of the first to migrate from November 2017.  The Service had been very clear in specifying requirements of what data needed to be captured in order to report back on the impact of services.  All young people had personalised goals and measured progress against them, which was working very positively. 

·              Waiting Times – Improvement on all Key Performance Indicators in August 2017 compared to March 2017.

Urgent referrals were still consistently seen within 24 hours and there was good triage.  Performance on the 3 and 6 waits for assessment for non-urgent referrals was continuing to improve.  Outliers for September data were still people coming for ADHD/ASD screening assessments and neuro-developmental assessments rather than people with significant concerns about their mental health.  This had been achieved through a multi-faceted approach - locality workers, referrals coming in that were more appropriate, and much more consultation/advice and guidance work with other professionals, families and young people directly. 

Waiting for treatment times had also significantly improved and the position was favourable regarding national benchmarking with data due in 2 weeks.  ASD assessments remained a challenge with 5 months’ wait for a diagnostic assessment but had improved from last year when it had been about 18 months and again Rotherham compared well with other areas.

·              Transitions – Transition events were planned with the Different But Equal Board (facilitated by Voluntary Action Rotherham) and within RDaSH there are monthly transitions meetings between CAMHS and Adult Mental Health Services.

This was an area of concern and nationally remained very high on the agenda.  It was generally about young people moving from CAMHS into Adult Mental Health Services but in Rotherham this was being looked at alongside some really positive developments around social prescribing, where some level of support was still needed but not through Adult Mental Health Services.  Internally there had been a listening into action learning approach to understand some of the challenges with transitions as the two Services operated quite differently.  A new temporary post had been funded that would sit across the two Services, working with 16-25s to reduce the impact of transition at a very vulnerable time of 18.

Discussion ensued with the following issues raised:-

·              Members were positive about their interesting visit to RDaSH CAMHS at Kimberworth Place on 24th October.

·              Had moving to the locality model of working led to a reduction in missed appointments? - They were probably a little lower but RDaSH’s DNA (Did Not Attend) rate was very low 6-7%, below the national average of 11%.

·              It was important to still retain self-referral to CAMHS, would this continue? - Yes self-referral and referral by families was in place, other than when people were questioning a request for ADHD or autism diagnostic assessment as those referrals needed wider information from schools and home.

·              Closer working between CAMHS and Early Help had reduced the number of inappropriately signposted referrals.  As a review of Early Help was taking place, although paused at the moment, could any future reduction in Early Help have an adverse impact?

This was more anecdotal information and more work was needed including what the performance structure and the monitoring would look like in terms of that collaboration at the SPA.  Early Help currently had around 1,600 families, and many more children, and what the Service hoped to see connected to this agenda was a bigger partner uptake of the Early Help assessment so the early intervention could be done around mental health, which could be connected to parental conflict.  Support for relationships was needed and bigger buy-in across partners.  It should just ensure referrals went to the right place rather than families bouncing around between Services.  This work would not lead to reduced need and volume but the key was early identification for Rotherham to have a healthy Early Help system.

·              Given the focus in timely and appropriate access to CAMHS some of the waiting times were still disappointing and although there was a big improvement in August was this sustainable?  How did you keep in touch with people who were having to wait a long time before they had their initial assessment?

       As referrals came in which required a routine appointment, families and the referrer were made aware of that and were also made aware that if there were any changes to their presentation or any additional concerns they could contact RDaSH.  People had been seen on a more urgent basis if there had been additional concerns.  RDASH felt much more confident that with the new approaches were sustainable.

·              Linked to waiting times, staffing had been a problem which impacted on undertaking assessments, so was there now a full complement of staff without the use of agency workers, to carry on improving? – Yes a full team was in place with just 1 agency staff member who would be moving to a Trust contract.  It felt much more settled.

·              What was the reason for the big improvement in performance in August on the non-urgent waiting times?

Commencing in May there had been a whole systems review of the Service, how referrals came in, how the Service responded to referrals and decision making on having an assessment.  This led to the new consultation and advice approach which was very different to the initial triage and assessment approach and allowed them to gather more information and do some further work with families, referrers, GPs and young people before making the decision as to whether that person went to a full assessment or not.  RDaSH were much more responsive and much quicker.  It took some months to bed in and initially the SPA had done that work but it was moved into the localities from about July which was when the big leap was seen.  Staff saw how they could work differently, quicker and leaner and more responsive to patient needs.

Resolved:-

(1) That the monitoring of progress against the responses to the Scrutiny Review of Child and Adolescent Mental Health Services be noted.

(2) That the Health Select Commission receive a further progress monitoring report in 2018.