Agenda item

Report of the Cabinet Member for Children and Young People

Councillor Mark Sutton, Cabinet Member for Children and Young People; Karen Coker, Senior Commissioning Manager; Natasha Moody, Strategic Commissioning Lead; and Sarah Newton, Commissioning and Development Officer attended the meeting to present the report and answer questions.  Unfortunately, a representative from the Clinical Commissioning Groups (CCGs) had not been able to attend.

The Children and Adolescent Mental Health Service (CAMHS) Transformation Board had set outs its intentions for a whole system and partnership approach to transformation, to align to the vision within the pan-Staffordshire Emotional Wellbeing and Mental Health Children and Young Peoples Strategy, via a Project Initiation Document and Project Plan.  The Strategy had been considered by the Select Committee in the past and had been endorsed by all parties, including all six CCG’s, Stoke on Trent City Council and the County Council.  The report provided an update on what had happened since then and informed Members that the Cabinet meeting on 18 December would be requested to authorise the new commissioning model.

The Plan consisted of 3 priorities; delivery of the strategy; improving pathways and whole system approach; and better access for those children and young people who require specialist intervention.

Information was also provided on the national mental health trailblazer (Wave one) which covered North Staffordshire and the Moorlands and included 31 schools (primary, secondary, colleges and alternative providers). Four Mental Health Support Teams (MHSTs) have been established, two in Stoke on Trent and two in North Staffordshire.  Educational Mental Health Practitioners (EMHPs) would provide support with low level, early intervention mental wellbeing needs.  More recently, East Staffordshire had also been confirmed as a Trailblazer site in wave 2.  This would include up to 30 schools.

Following a question on why North and East Staffordshire had bid for trailblazer funding but not the central areas of Staffordshire such as Stafford, the members were informed that it had been the CCGs who had chosen the areas and bid for the funding and that other CCGs could bid in future rounds.

The Committee was informed that currently there were two services which provided support which included four Tier two contracts commissioned by the County Council valued at £301,016 per annum, and a bespoke jointly commissioned contract to deliver a service for Looked After Children (LAC) and care leavers, with an annual contract value of £584,259.  The contracts would come to an end on the 31 March 2020 and the funding from both the County Council and the CCG’s had been pooled to enable a new service to be jointly commissioned.  One lead provider would be in a better position to ensure consistence and a simple pathway into services.

The new service will have a robust performance framework.  The two trusts (MPFT and North Staffs Combined Healthcare) would want to capture the softer outcomes along with what they need to report on to DfE regarding the Trailblazer pilots.

The consultation process was outlined, the result of which had led to the remodelling of the service.  The 2020 Emotional Health and Wellbeing Service would offer: Digital support; Direct support; Preventative work; Risk Management (Intense support for high risk children and young people); and a clearer pathway into other services such as Adult services or Acute care.  All the services would run alongside those offered by schools.

The LAC and Mental Health pilots were for 5-11 year olds, who had spent three months or more in a Staffordshire County Council foster care placements.  This pilot would focus on carrying out improvements to assessments that ensure they:

·         Are good quality, enabling accurate identification of need

·         Occur at the right time

·         Are needs focussed and person centred.

Following a question on the number of children the LAC pilot was aimed to support, the Committee was informed that due to the relatively small amount of funding received, 30 to 40 children in care would benefit. It was explained that this was one of six waves of trailblazers and there would be more opportunities to bid for more funding in the future.  The results of the pilots would be analysed by the Department for Education (DfE) and could be used to mainstream services in the future

There was concern that support was being centred around schools which were already struggling to meet demand. 

There had also been an increase in the need for support in the form of medical assessments which were taking up to 3 months to access. The number of beds commissioned out of the County was also questioned.   It was informed that the Tier four services provided by the CCG’s were part of another contract but information on the number of out of county child placements used would be requested from the CCGs. 

It was felt that the digital offer was not a replacement for face to face contact even though there was a place for simple low level information being available online.  It was hoped that the new approach and dealing with one provider (contract) would help to improve the service and streamline services.  Digital, was part of this offer and particularly benefited children placed out of the county who could still access the Digital Offer regardless of their location.

The Committee felt that there was a lack of information on the timescales involved; how social media would be tackled; and the link between physical and emotional health.  It was confirmed that more work needed to be done on linking physical and emotional health, but Members were reassured that the services did recognise this.  In terms of social media, the feedback received from consultees had been positive and this had been used to educate and encourage dialogue with young people.  Timelines between referrals and receiving support was estimated to remain the same.

A Member felt that there was a missed opportunity in ensuring that partners and agencies were digitally linked, and information shared automatically.  Officers informed the committee that often young people wanted to remain anonymous so information couldn’t be collected or shared.  There would still be opportunities to change the specification of the contract if needed.

The services provided under this contract were low level Tier one and two.  Partners should provide a whole family approach and should be looking at early intervention to prevent children requiring services in the first place.

Healthwatch informed the Committee that from the work they had done in schools there was concern that reduced funding was affecting the ability to offer support.  In response, Members were informed that the budget for the Emotional Health and Wellbeing service had not reduced and if problems were identified earlier these may be dealt with by the family, the community and the organisations who already knew the young people first before needing additional help from a service.

There were also other initiatives/boards in place such as the Maternity Transformation Programme Board (MTPB) whose remits were aligned to emotional health and wellbeing.  The MTPB has a subgroup regarding Perinatal mental health and the Families Health and Wellbeing Service which includes emotional wellbeing as a high impact area within the contract. This new service was meant to compliment not duplicate the support already available through existing services / support.

Figures reported in the Local Transformation Plan for 2017/18 in relation to ‘Total number of individual CYP aged 0-18 receiving treatment from CAMHS services in the reporting period’ were explained.  There had been an historical lack of understanding regarding the algorithm for the new indicators.  It had been a national problem that had been rectified and meant more accurate data would be available from this year.  It was expected that the data for 2018/19 would be accurate and would be formulated in the same way as the previous year.

When discussing the effects of social media on children’s mental health the Five Rights Foundation was highlighted as good practice.

RESOLVED:

a)    The Select Committee supported the new approach subject to the following being addressed;

·         timescales needed to be clearer

·         more support into the prevention of negative consequences of social media

·         the link between physical health and its relationship with mental health being included in the plan. 

b)    The Committee also asked for service provision to include exit interviews; more digital links with partners; and emphasis on early years identification prior to services being needed.