Agenda item

A Presentation was circulated as part of the agenda pack. Catherine Swaile, Vulnerable Children’s Joint Commissioning Manager, gave the presentation to the Board on the review of Haringey Children’s and Adolescent Mental Health Services (CAMHS). Following the presentation the Board discussed the findings.

Some of the key points raised in the presentation were:

• The review was linked to Ambition 7 of the Health and Wellbeing Strategy, more children and young people will have good mental health and wellbeing. The performance measure for this ambition was based on a survey that was being developed for school children, based on the Warwick-Edinburgh wellbeing score for children and young people. As the process was not finalised, a target had not yet been set for this ambition
• The Department of Health published a report earlier this year called Future in Mind: Promoting, protecting and improving our children and young people’s mental health and wellbeing.The report identified participation and collaboration as a core principle, promoting services designed in collaboration with children, young people and families to meet their needs. The report also contained 49 proposalsto transform the design and delivery of a local offer of services for children and young people with mental health needs
• Haringey’s allocation of the £280m Transformation fund for CAMHS announced in the Autumn Budget was £515,302, recurrent for 5 years.
• CAMHS Review Project Board were leading the review of Haringey CAMHS, comprising representatives from the CCG, the Council, NHSE, CSU and Healthwatch.  The process involved an engagement event for over 50 people in March and a follow up event was booked for 18^th September to feedback on the review outcomes and to develop a transformation plan. Themed workshops were held on Looked after Children, Children with Learning Disabilities/ASD and Crisis.
• In addition, online surveys were conducted with feedback from 152 stakeholders including both children and young people and parents.
• Participation in the review was received from all providers to ascertain what the issues were in mental health and to see what improvements could be made.
• The latest estimated prevalence data showed that low level universal support was required by around 9000 children or young people in Haringey. No data was available for the numbers or Haringey’s commissioned activity.
• Ms Swaile identified a significant gap at the next tier of support up, where a mental health professional was working with a family (but not as part of a multi disciplinary team) where Haringey commissioned around 300 services across health and social care but would expect about 4000 people requiring a response.
• Haringey’s commissioned activity was around 1200 cases for multi- disciplinary specialist care services, against an estimated 1150 cases.  Ms Swaile commented that this suggested an escalation of cases because need was not being met at the tier below.
• The number of cases at tier 4, which was classified as highly specialist inpatient services, was below what the estimated prevalence data would suggest with 17 cases against an estimate of around 50.
• Feedback was positive in terms of the quality of service. Feedback also indicated that improvements needed to be made in; crisis management, availability of choice, waiting times, inter-agency working, Looked After Children services IT infrastructure and concerns were raised about inadequate safeguarding training.

The Board noted that transformation plans needed to be submitted on 16^th October and that these would require Chair sign-off. The transformation plans would be based on the outcomes of CAMHS review. 

Jon Abbey, the Director of Children’s Services raised a query regarding the future model and transformation, requesting some further detail on the future operating model and where the prevalence scores suggested in the presentation might fit in with Early Help and schools. The Director of Children’s Services also commented that the presentation highlighted the difficult transition for 16-18 year olds and raised concerns with the fragility of the workforce in regards to safeguarding training.

Ms Swaile responded that one of the key conclusions of the review were that there was a lack of support at tier 2, a lot of which could be developed in conjunction with schools, and that this required  much more coherence in terms of planning. A further key conclusion identified by the review was that the lengths of interventions in CAHMS were longer than the national average. The concern therefore, was that dependencies were being built and the challenge was to ensure that people were getting useful interventions at the right time and that people were not being held in services. The Board noted that transition became difficult when children were held in services inappropriately, because they didn’t meet the threshold for adult mental health services but discharge was equally unsuitable.  

Sir Paul Ennals, Chair of Haringey LCSB, commended the presentation and commented that there were close links to the enablement model. Sir Paul agreed that the key concern seemed to be strengthening the links at tier 2 and identifying what the evidence showed were the key interventions that could reduce the flow of children and young people up into tier 3. Sir Paul added that in terms of the enablement model, there was evidence to suggest that intervening at the time of initial attachment was the most cost effective time of intervening and the most effective way of reducing the later flow of needs.

Ms Swaile agreed that developing a proper attachment pathway was key and was one of the main areas that had been identified to be taken forward. A lot of work already took place on working on attachment with families but it wasn’t coordinated. The Board was advised that there was a high level of provision in Haringey, CAHMS spending was appropriate and a number of successful outcomes were achieved. The main issues revolved around coherence of planning and alignment. Sir Paul added that there were other conclusions to be drawn around the enablement link; namely more powerful use of the voluntary sector from within the community and shifting the focus of front line delivery away from highly trained mental health professionals to other providers who were much closer to home. There were a number of models within the voluntary sector that should be reviewed and considered.

Mr Wilson advised that the wider report that the CAHMS presentation was drawn from contained some equalities issues that were not reflected in the presentation. The equalities issue related to the number of referrals in the central and south east being lower than the west. Mr Wilson recommended that these issues needed to be flagged up as part of this work. Ms Swaile acknowledged the discrepancies outlined and suggested a possible correlation with lower referral rates for Black African and Black British African demographics and suggested that targeting certain areas with high proportions of certain communities may improve the referral rates. Ms Swaile advised that further work would need to be undertaken to look into this issue.

Sir Paul queried what the Board was being asked to do in relation to this paper. Ms Swaile responded that the paper was for information purposes and to update the Board on current progress. Ms Swaile stated that she would like to bring the more detailed transformation plan

Back to the Board for approval prior to its publication on the Council and CCG website in November. Dr de Gruchy advised that the next meeting of the Board would fall too late to bring a subsequent paper back to board and reiterated that the purpose of this item was so that the Board could have a conversation about the review of CAMHS, particularly prior to it going to public consultation.

The Board agreed that any comments would have to be fed back outside of the Board on an individual basis to Catherine Swaile. It was noted that the timescales for the review were nationally driven with the planning guidance issued in August and a final submission deadline of October.

The Chair thanked those present for their contributions.