Report to NHS Dorset Clinical Commissioning Group Clinical Commissioning Committee

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Randolf Ramsey
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1 AGENDA ITEM 4 APPENDIX 5 Report to NHS Dorset Clinical Commissioning Group Clinical Commissioning Committee EMOTIONAL WELL-BEING AND MENTAL HEALTH OF CHILDREN AND YOUNG PEOPLE Date of the meeting 16 December 2016 Author Purpose of Report Stakeholder Engagement K. Halsey, Senior Programme Lead J. Brennan, Head of Programme Maternity and Family Health Clinical Delivery Group (CDG) To update the Committee on the key elements, of this priority CDG workstream, progress to date and future plans. High engagement has occurred with young people and more is being planned with a range of stakeholders as appropriate into the specific topic areas within this workstream. 1. Introduction 1.1 The need for improvement in the emotional well-being and mental health (EWB&MH) of children and young people is a priority nationally, regionally and locally. 1.2 Key national drivers include the publication of Future in mind: Promoting, protecting and improving our children and young people s mental health and wellbeing and the Access and Waiting Time Standard for Children and Young People with an Eating Disorder in The five overarching themes of Future in Mind are: Promoting resilience, prevention and early intervention Improving access to effective support and the creation of a system without tiers Care for the most vulnerable Accountability and Transparency Developing the workforce 1.3 Locally it is a key priority of the Maternity and Family Health CDG within the local transformation of health services agenda. The pan Dorset Joint Commissioning Partnership for Children and Young People (CYP) has also 1

2 agreed EWB&MH is a key priority for the CCG and the three local authorities including Public Health Dorset. This group will oversee the joint commissioning arrangements to support this priority in Dorset. 2. Report 2.1 The current position for this workstream includes the following key elements. 2.2 The CAMHS Review (Feb. 2015) highlighted a number of areas for further development. These and the progress to date, are outlined in the table below: Improvement Identified Access to Services (Waiting Times and DNA) Training and Support to Tier 1 by CAMHS workers. Progress Pathway changes made to address waiting times, including triage and assessment directly into individual support pathways Self-help digital apps and websites are offered Audit and review of all cases waiting and risk log developed Additional temporary capacity introduced including offer of evening appointment times Improved staff support and supervision to improve management of long-term cases Team level performance dashboard developed by the service supported by weekly reporting of waiting lists to managers DNA s have reduced slightly overall pan Dorset DHC text service to be broadened to include CAMHS CAMHS project team developed to look at new uses of technology and social media such as website, e-clinics and online self-referral. Pilot of a CAMHS worker located in Bournemouth Borough Council Early Help Team (Jan 2016 for a 12 month period). Plan to trial the PPEP (Psychological Perspectives in Education & Primary Care) training resource developed by Reading University as part of the CYP IAPT Programme - Six staff are trained to deliver modules on Anxiety, Self-Harm and Depression. Current training is running from September- April 2016 and more dates will be delivered by Reading University to expand this programme. All schools now have PMHW allocated to their cluster, further work is needed to identify resource to strengthen support in West Dorset due to large geographical locality. A Toolkit for GPs developed by Dr Maryanne Freer to help support education of GP s this will be part of the 2

3 Communication, Engagement and Participation Pathway for EWB&MH support of Looked After Children (LAC) and Care Leavers Support for CYP with Behaviour Development Pathway (ASD / ADHD) DHC Communication and Engagement strategy with GPs from January Preparing for Change PowerPoint presentations for Early Help and Self Help have been developed along with mobile apps for e.g Depression, Anxiety, and Obsessional Compulsive Disorder (OCD). Roadshows and workshops are being organised to share this with the wider children services workforce from January DHC Pan Dorset training programme on RIO launched to ensure consistency in the recording and communication of patient information CAMHS offer, scope and threshold document has been produced Referral Guidance for Local CAMHS which details what the service does, how to make a referral, factors to include in a referral and other helpful information - this will be part of the DHC Communication and Engagement strategy to GPs, Schools, Voluntary Sector and other Stakeholders starting from January Plans developed to address participation and involvement of young people in CAMHS activities, (e.g. interview panels, co-production of training, peer mentoring, input into project developments such as improving waiting areas and inductions for new staff.) Work has commenced and an initial meeting with young people has taken place to agree a workplan commencing from March Review of the service to identify gaps and develop a countywide plan. Business case developed by DHC for additional resource for EWB&MH of LAC, Care Leavers, including support for those in children s homes, with Education and Health Plans (SEND) up to age 25 and to those in out-of-area placements. Approach to be agreed by March A new pan Dorset Behaviour and Development Pathway (ASD/ADHD) has been developed locally, and is being implemented across partners. Additional resource has been identified by the CCG for Case Co-ordinator roles to support the pathway via DHC. 2.3 In additional investment had been made available to Dorset HealthCare (DHC) via the Parity of Esteem funding. This has resulted in the following: Recurrent funding totalling 318k (details of the business case are included in Appendix 1). This funding increases capacity to undertake; 3

4 Hospital liaison and emergency deliberate self-harm assessments. Dedicated Nurse Prescriber roles. Pilot the location of a CAMHS worker in the Bournemouth Borough Council Early Help Hub (Access to Resources Team ART) and to start development work to be able to support young people through social media and an online help. This has been supported by DHC through non-recurrent investment of 38K. Additional in year funding of 68K for co-ordination roles to support the new local Behaviour and Development Pathway (ASD/ADHD). This funding will be picked up through the national Transformation Funding for onwards Local Transformation Plan NHS Dorset CCG has submitted and received assurance from NHS England of our Local Transformation Plan to improve EWB&MH for CYP on behalf of our local partnership. The assurance of the Plan has resulted in the allocation of additional national funding specifically for children and young people s emotional well-being and mental health including eating disorders (as per previous announcements in the 2014 Autumn statement and 2015 Spring Budget). This new funding for the Dorset CCG area totals 1,551,573. Initial allocation of funding for eating disorders and planning in 2015/16 Additional funding available for 2015/16 when Transformation Plan is assured Minimum recurrent uplift for 2016/17 and beyond on assurance of plans (i.e. sum of two rows above) 442,914 1,108,659 1,551,573 Our Transformation Plan will be published on-line during December Future work will focus on: The Plan includes improvements that will be achieved through both new funding as well as better use of existing local resource. Elements that will utilise new funding Roll out of the principals of the CYP IAPT Programme Expert by Experience (peer) project Early Intervention and Prevention: 4 Areas for improvement within existing resource Resilience Building Improving Engagement and Participation of Children, Young People and their Families

5 improvements in and support to Schools and the School Nursing Service and Children s Centres (LA s) Targeted Support for the most vulnerable including LAC, Care Leavers and CYP who have experienced abuse Liaison and support though other professionals and services such as Early Help Hubs and acute hospitals Behaviour and Development Pathway (ASD / ADHD) Community post in CCG to oversee the implementation, co-ordination, performance and monitoring of our Transformation Plan Young People s Eating Disorder Service (YPEDS) Crisis Care Youth Health Champions (Peer Support) Transition Specialist level secure provision for complex needs and linking to in-patient provision and CAMHS Outreach service Health and Justice Children with a Learning Disability and mental health disorder Perinatal Mental Health Workforce development Troubled Families Street Triage Children s Sexual Exploitation (CSE) and Missing Children s Service Young People s Eating Disorder Service (YPEDS) A business case has been developed and agreed with DHC for additional funding to the service to support the requirement in the new Access and Waiting Time Standard for Children and Young People with an Eating Disorder. This resource will increase the capacity of the service through additional staffing to support the: Prevention and early identification agenda, Achievement of the new waiting time requirements, Access to the same levels of care at the weekend as in the week, Service to work with co-morbidities, thus reducing the pressure on CAMHS teams. Recurrent funding will follow our Transformation Plan later this month - December Pan Dorset Children & Young People s Emotional Wellbeing and Mental Health Strategy 5

6 Our new Strategy is currently being developed for An initial draft has been written and a version will be presented to the Pan Dorset Joint Commissioning Partnership for Children and Young People in January Following consultation it is anticipated that the Strategy will be published in April The Strategy will bring together all associated local service development, improvement and action plans across partner organisations. There will be a single, co-ordinated pan Dorset (currently 3 LA s) implementation plan that will clearly outline the roles and responsibilities of each partner and organisation, including families and schools. This will enable monitoring of progress across all workstreams including monitoring against commissioning outcomes inclusive of KPI s and the use of this new investment within all workstreams (in our Local Transformation Plan). The implementation plan will also be published in 2016 and updated to reflect progress All Age Psychiatric Liaison Service Work is being undertaken between the Mental Health and Maternity & Family Health CDG s to invest in the development of an all age Psychiatric Liaison Service. This would bring together the current adult provision, the in-year additional funding allocated through urgent care to pump prime new initiative and the work relating to children and young people through service development and our Local Transformation Plan. This additional requirement needs to be in place by Author s name and Title : Kate Halsey, Senior Programme Lead Jane Brennan, Head of Programme Maternity and Family Health Programme Date : Telephone Number :

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8 Appendix 1 DORSET HEALTHCARE NHS TRUST PROPOSALS FOR PRIORITY INVESTMENT IN CAMHS 2015/16 Priority Schemes Hospital Liaison and Emergency Assessments and Deliberate Self Harm Poole, Bournemouth and Christchurch and East Dorset CAMHS Teams. Time Scale Outcomes Comments Annual recurrent cost including Trust overheads November 2015 A dedicated worker will be recruited to improve communication and liaison with colleagues in the general hospitals To free crisis workers in the teams from undertaking DSH assessments to allow them to undertake intensive home based crisis interventions to prevent in patient admission The worker will be based with the adult liaison team for support, serving Poole and Bournemouth Hospitals The postholder will be part of the DSH pathway in and out of hours staff to ensure effective handover of day cases to out of hours staff to avoid bed blocking which is a concern for our Acute colleagues 42,576 To provide training and consultation to staff in physical health setting To reduce referrals to CAMHS from physical health settings and improve access 8

9 Priority Schemes To introduce dedicated Nurse Prescriber roles to support CAMHS Teams Pan Dorset Time Scale Outcomes Comments Annual recurrent cost including Trust overheads November 2015 Two dedicated posts will support Consultant Medical Staff to manage ADHD and Autistic Spectrum Disorder patients. This will support: Reduction in waiting times to see a Medical Consultant Currently Consultant caseloads are too large. The additional Nurse Prescribing roles will work closely with Medical Consultants to ensure effective management and regular review of patient group 100,400 Increase capacity for Consultants to offer consultation and support to team members and to manage complex cases Increase capacity for Consultants to further develop links with GPs and other external agencies To Improve Skill Mix across Weymouth and Portland, North and West Dorset to facilitate Hospital Liaison and Emergency assessments and Deliberate Self Harm November 2015 Cost effective solution to managing young people with most complex needs The improved skill mix within Tier 3 CAMHS will release capacity for a Duty worker to support emergency assessment to make the team more responsive to requests from Dorset County Hospital for DSH assessments. 9 Weymouth and Portland Team is working closely with Social care and GPs to trial a new approach. A workshop has been planned for October. This team has great difficulty recruiting to the vacant Consultant Psychiatrist post. 29,253 (Behavioural Nurse Practitioner) 36,568 (Occupational Therapist)

10 Priority Schemes This will be achieved through the appointment of an additional 0.8 wte Behavioural Nurse Practitioner and 1 wte Occupational Therapist Time Scale Outcomes Comments Annual recurrent cost including Trust overheads To free crisis workers in the teams from undertaking DSH assessments to allow them to undertake intensive home based crisis interventions to prevent in patient admission Improve liaison, training and consultation with the Paediatric staff and provide an improvement in and Out of Hours DSH pathway The post of Behavioural Nurse Practitioner will also work closely with the Consultant to manage complex cases making the post more attractive to applicants In North Dorset the additional capacity will provide a focussed approach and improve liaison with Yeovil Hospital To appoint a Development Worker to work Pan Dorset to improve Pathways and Training Programmes November 2015 The post holder will Develop pathways Pan Dorset with Local Authority and Voluntary Sector Partners The focus of this post is to improve Early Intervention and Preventative work 45,000 Support Early Intervention and school facing work Pan Dorset Integrate Pan Dorset LAC development Priority Schemes Total 253,797 Time Scale Outcomes Comments Annual recurrent cost including Trust overheads 10

11 Priority Schemes Pilot model for Early Intervention/Prevention with Bournemouth Borough Council (ART) Support to young people through Social Media and Online Offer Time Scale Outcomes Comments Annual recurrent cost including Trust overheads December 2015 TBC To implement six month pilot of Early Intervention/Prevention work based with Bournemouth ART team and evaluate success of model to inform future Service Delivery Deliver new vision for supporting young people Pan Dorset via single gateway in partnership with Local Authority Partners Improve access for young people and improve engagement Meeting scheduled for first week in September 2015 with Bournemouth Borough Council to finalise proposals An outline proposal to support young people through social media has been developed in partnership with Bournemouth University A workshop has been planned with Local Authority Partners for Autumn 2015 to develop these proposals further 18,000 non recurrent funding from Dorset HealthCare Trust 20,000 set up contribution from Dorset HealthCare Trust investment Introduce self-help information, resources and online helpline and advice Overall Total 291,797 Of which 253,797 is recurrent investment required from CCG 38,000 non-recurrent funding from Dorset HealthCare 11

Warrington Children and Young People s Mental Health and Wellbeing Local Transformation Plan

Warrington Children and Young People s Mental Health and Wellbeing Local Transformation Plan 2015-2020 1 Introduction 1.1 Welcome to the update on Warrington s Local Transformation Plan for Children and