Agenda item

This report seeks to integrate the work and findings of the Hammersmith and Fulham CAMHS Taskforce with the Hammersmith and Fulham Future in Mind Transformation Plans which have been submitted to NHS England. 

Councillor Vaughan welcomed Angela Caulder, Joint Commissioning Manager, and, Fiona Murray, Transformation Manager, North West London CCGs, who jointly presented the Children and Young People’s Mental Health (CAMHS) ‘Transformation Plan’ Update.  The report brought together the findings of Councillor Alan D’eath’s Child and Adolescent Mental Health Taskforce Report 2016 and the development of the CAMHS transformation plan.  In 2015, the CCGs in collaboration with local authorities, agreed proposals to improve mental health services for young people, which included establishing a community eating disorder service for under 18s, and, to ‘transform’ local mental health services for young people in line with the recommendations made in ‘Future In Mind’.  Angela Caulder highlighted the following three achievements:

·         The H&F schools pilot, a successful bid to become one of fifteen national sites.  This linked ten schools together with CAMHS provision from the West London Mental Health Trust, with two hours per week in school (with a specially trained mental health lead in each school) and several young people seen in school, with a further four schools added to the programme, now extended to March 2017;

·         The eating disorders service, established on 1^st April 2016, in collaboration with Ealing and Hounslow CCGs, as a hub (Ealing) and spoke (LBHF) model.  This was as self-referral service, with cases being seen within four weeks, and, a one week wait for urgent cases and linked to the CAMHS national specifications for eating disorders; and

·         Out of hours’ service, working with 8 CCGs across North West London, involving both Central and North West London Foundation Trust (CNWLFT) and the West London Mental Health Trust (WLMHT), which had received positive feedback, with the pilot being continued.

In terms of next steps, there were several actions required, including the further integration of CAMHS within existing mental health provision, and, for local authority supported, early intervention help in schools and within the wider local community.  Fiona Murray explained that they were working towards developing seamless transition, alignment, and provision with other boroughs, highlighting the mental health referral route and ensuring that the provision is sustainable.   In terms of co-production, it was explained that flexible approach was required and that they were working with Rethink, to develop a strategy for LBHF, WCC and RBKC.  A children and young people conference was planned, to better understand what worked well and what could be improved, highlighting the use of apps and whether these were helpful.

Councillor Perez welcomed the report and commended the encouraging approach undertaken which was notably child-centred.  She sought confirmation about how inpatient beds translated at local level.  Angela Caulder explained that within H&F, children did not spend long in A&E.  Those that did were offered a CAMHS professional and could be discharged without seeing a doctor.  They were looking to increase the number of beds available in 2017/18 and it was noted that whilst there were sufficient beds in London, there was significant take up of them from patients outside London, creating further pressures.  WLMHT and CNWL were working jointly on one-year pilot (from April 2017), a new model of care to establish community based, priority local beds for local children.  This was in partnership with the Priory Group, who would provide the beds.

Councillor Carlebach also welcomed the report and asked if they had engaged with young people who had learning disabilities, or had approached organisations such as Mencap or the National Autistic Society for input in developing CAMHS services.  It was explained that Mencap had contributed when they had attended one of the Anna Freud seminars, in September 2016.  Whilst there had not been large numbers of young people with learning disabilities contributing to the development of CAMHS, several charities and organisations had contributed, together with parent champions.

Patrick McVeigh referred to page 24 of the report, and the admission to in-patient rate of 13.4% per 1000 of the and whether this could be viewed as positive or negative.  Angela Caulder responded that this was not a question she could answer as the data was from NHS England, covering 2014/15 and could not be viewed as comprehensive.  It was agreed that more current data would be sought for inclusion in the report being submitted to the Health and Wellbeing Board meeting the 14^th November.

ACTION: CCG

Responding to the issue of transition raised by Patrick McVeigh, Angela Caulder concurred that this had been a long standing concern but offered assurances that the number of children that required transition support services at this age was relatively low.  It was noted that the eligibility criteria for adult services was significantly lower.  Whilst children with mental health needs that were transitioning would also usually have a comprehensive Local Offer in place, this would end at 18.  Normally, there would not be a difficulty in transitioning unless an individual found it difficult to engage with the new, adult service.  Angela Caulder informed them that they were currently piloting a tapered transitions model of care for 14-25 year olds with learning disabilities could elect to continue to be seen within the CAMHS service.  The pilot would require a pooling of budgets and formed the basis of on-going dialogue amongst health, adult social care and children’s services colleagues.  Patrick McVeigh questioned whether this approach would succeed in addressing the challenges of transitioning.  Fiona Murray acknowledged that whilst there was considerable work to be undertaken, her role was to identify the way in which the pilot was successful, how this could be replicated and the mechanisms by which it could be made to be effective and sustainable.

Councillor Brown welcomed the report but commented that he would have liked to have seen a greater focus on addressing factors such as drug abuse and how this impacted on young people’s mental health.  From his experience as a governor at the Bridge Academy, he had encountered several cases, where the misuse of drugs had been a significant factor affecting the mental health of a young person.  In response, Councillor Fennimore informed the Committee that a meeting was planned with MIND the following week.  It was recognised that whilst this had been a continuing problem for several years, MIND had advised her that recent figures had shown improvement, as result of the approach taken by the current administration, although there remained much work to be done.   Councillor Fennimore explained that she was currently on the board of governors at the Bridge, and that there was a significant amount of work on going around drugs misuse and the link to mental health.  They were examining the work of the youth offending service in the context of mental health provision, encompassing restorative justice, to address concerns early on.

Bryan Naylor highlighted the issue of those parents who were less able to navigate the network of services and providers, or those who struggled to find the support necessary for them to best assist their children.  He was concerned that the same experiences encountered personally for his extended family ten years previously, remained unchanged.   The most significant factor was the support, knowledge and expertise of individual social workers.  Angela Caulder responded that whilst she acknowledged the challenges inherent within the existing system, diagnosis of neuro-developmental disorders took up to one year to establish, and that waiting times within the borough were amongst the lowest in the country.  She continued that there were many different support services available within LBHF, some of which were duplicated and she acknowledged that there was a lack of awareness about services.  Information was available online, together with a resource pack which was provided to parents. It was recognised that there was a need for a greater integration of services and that the variety of appointments needed required greater co-ordination and consolidation, benefiting from a joined up approach with possibly co-located teams.  The aim eventually would be to have a more integrated, child centric service. 

Councillor Vaughan summarised the main points of the discussion which included the achievements of the transformation plan to date and the notable contribution of the Taskforce Group in producing their report, the stigma associated with mental health illness and the responsiveness of the local authority in ensuring the provision of CAMHS.  Members agreed that they would like to continue to monitor the development of the CAMHS transformation plan and that it be added to the work programme.

RESOLVED

1.    That the Committee continue to monitor the on-going work on developing sustainable Children and Mental Health Services and include this in their Work Programme for 2016/17; and

2.    That the report be noted.