Agenda item

The Board requested a report on the work of the Humber and North Yorkshire Integrated Care Board. The purpose of this report is to:

a.   Set out current work to improve children and young people's health at a system and York place level by the Humber and North Yorkshire Integrated Care Board and the York Health and Care Partnership;

b.   Share proposals to build on this and to improve governance to strengthen and improve collaboration and partnership and evidence-based planning working across the health and care system. This will deliver improvement against priorities in key Integrated Care Board and York strategic plans;

c.   Ensure the Board is aware and can contribute to the development of forward plans to continuously adapt to change, taking bold action by trialling new and emerging ways of working to improve early intervention and access to services for those who need it, reduce waiting times, and improve outcomes. This will include addressing health inequalities for vulnerable groups and will ensure the voice of Children and Young People with lived experience informs developments, delivery, and improvements in provision.

The York Place Director introduced the item, including a PowerPoint presentation on Children and Young People’s Health in York, incorporating a one-page summary of the Integrated Care System (ICS) Strategy outlining the aims and outcome priorities, with representation from all sectors.

She also introduced the strategy of Core20PLUS5, which is an approach designed to drive targeted action in healthcare inequalities improvement; it was explained that “Core 20” referred to the 20% most deprived members of the population as identified by the Index of Multiple Deprivation, and the “Plus 5” referred to 5 population groups selected by the ICS, who were experiencing poorer than average health access, experience or outcomes.

Representatives from the Integrated Care Board, who had co-authored the report, then further discussed elements of the presentation in detail and responded to questions from the board.

The Programme Lead for Children and Young People's Mental Health, further elaborated on the Core20PLUS5 and presented a video entitled “Nothing About Us Without Us” discussing young people’s top four priorities for mental health:

1.    Young people led awareness-raising and training on the signs and symptoms of mental health problems, and issues impacting young people’s mental health, including LGBTQ+, racism, etc.

2.    Easier access to services.

3.    Young people leading on work and courses about children and young people’s mental health, to ensure their voices are heard, their lived experience is valued, and they are not “shrugged off” by professionals.

4.    Listen to young people more.

She stated that young people’s involvement with the development of the mental health strategy had been productive and successful.

The Senior Commissioning Manager Children and Young People discussed the offer for emotional and mental wellbeing using the “I thrive” model which was generally self-directed, with support and advice from specialist services such as York Mind, Beat (the National Eating Disorder Service) as well as Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), Child and Adolescent Mental Health Services (CAMHS), Improving Access to Psychological Therapies (IAPT), Wellbeing in Mind and the School Wellbeing Service (SWS). She explained that this model moved from signposting, through increasing levels of assistance and involvement.

She summarised how these services are employed, working with schools and social care, to facilitate good mental health for children and young people in York and discussed funding and challenges.

The Senior Quality Lead for Children and Young People at York Place discussed physical health and services focusing on the five vulnerable groups identified by Core20PLUS5; she advised the board:

·       That a post was being set up with funding from York Place, to enable children with asthma to live a normal life.

·       That continuous monitoring and support was being offered to children with Diabetes across the ICB.

·       That integrated bowel and bladder workshops in partnership with the Healthy Child Service were being established.

·       That significant work had been undertaken with therapies teams at York hospital to reduce long wait times for children with sensory/processing difficulties.

The board thanked the presenters for their report, noting the quality and comprehensiveness of the presentation.

Board members expressed some concern that the presentation itself had not been incorporated into the pack.

The board asked for further information regarding the transition from Childrens Social Care to Adults Social Care concerning support for mental health, and whether the ICB had looked to other authorities Integrated Care Strategies for guidance regarding good practice?

The Programme Lead for Children and Young People's Mental Health responded that a working group across the six Places within the ICB was focusing on a consistent approach to mental health, aware that people may live in one area and work/school in another, and a move away from an age-led approach towards a needs-led approach. She said that having young people stay within a particular service until a need is met rather than a specific birthday, or having a key worker to guide them can useful in avoiding a “cliff edge” at 18 years.

Regarding the board’s question concerning best practices, she answered that she liaised regularly with her counterparts in West Yorkshire and South Yorkshire, and she was quite keen to take guidance from other authorities, but also the Humber and North Yorkshire ICB’s work on Trauma Informed care was leading the way nationally.

She went on to discuss the need to adapt for new or emerging issues such as Avoidant/Restrictive Food Intake Disorder (ARFID), which she distinguished from traditional eating disorders on the basis of the response required. Senior Commissioning Manager Children and Young People added that the shortage of specialised staff is also an issue across the ICB, particularly when dealing with specialist areas such as ARFID.

Board members raised the example of the East Cambridge model, which utilised social prescribing to lessen the burden on specialists – and asked whether the ICB might be able to do more in the community utilising this model?

The Programme Lead for Children and Young People's Mental Health answered that this highlighted the importance of the list of priorities for each place to best deliver change in each area. The Director of Operations and Transformation, TEWV NHS Foundation Trust added that work was being done in Adult Services regarding the Community Hub concerning the range of early interventions prior to reaching specialist Services and this absolutely needed to be part of the children's work too going forward.

The Programme Lead for Children and Young People's Mental Health added that whereas the ICB were very good at escalating/”stepping up” young people to CAHMS they also needed to work towards a more graduated drop down.

The board discussed family members of children, especially those with specific concerns such as neurodiversity or gender identity, and how they could find someone within the system who was equipped to help them holistically; it was hoped that patients with ongoing health concerns as part of their identity could have these taken into consideration alongside transitory health issues and not have to choose which issue they would like to have dealt with in isolation.

The board also expressed concern at the confrontational nature of parents seeking the best assistance for their child, and the fact it was often presented as a “fight” where healthcare inequalities could be greater dependant on a child’s particular condition, dependent on how well their carer was able to advocate for them and dependent on which area they lived. They suggested that better communication was required from healthcare professionals to patients and their families, for example regarding waiting lists.

The Programme Lead for Children and Young People's Mental Health responded that this was very much where the feedback and recommendations from young people had led, with over 80% of respondents had made very modest recommendations concerning communication, such as young people not buying stamps. The Senior Commissioning Manager Children and Young People added that the School Wellbeing Service and Wellbeing in Mind are in all/most schools in York respectively and have overwhelmingly positive feedback but unless it is on their phones, many young people do not express this feedback via forms. For this reason a feedback app was being developed (with digital poverty in mind).

Board members suggested that the public speaker and the upcoming Healthwatch report exemplified that information and advice was not always successfully being conveyed to people – it was suggested that greater proactive contact with patients/families before or during the transition between Childrens Social Care and Adults Social Care could be beneficial.

The Senior Commissioning Manager Children and Young People agreed with this point, commending the Healthwatch report and proclaimed Healthwatch to be one of the key guides she would recommend for mental health. The Programme Lead for Children and Young People's Mental Health added that Centre for Voluntary Services are also very useful, and that she had been doing normalising work with York Mind regarding how podcasts and positive social media (included self-generated material) could further be used to pre-empt young people first hearing about things from a doctor.

The board further enquired whether the funding for York Mind would be continuing, given it was cited as a key service, and whether it may be subject to potential future cuts since the flow of money comes from council.

The Programme Lead for Children and Young People's Mental Health answered that the forward plan would look at where spending was best prioritised within the ICB on different areas. The Executive Member for Children, Young People and Education responded that York Mind was funded by the Local Authority and the executive would reassess contract when it was due for renewal.

The Programme Lead for Children and Young People's Mental Health stated that the forward plan needed to be systems-based and it had to be about all services united; be they national, regional or local, because actually these were all interlinked at the point of delivery, and ultimately young people just want to know there is help there that could benefit them.

Board members agreed that mental health was a complex issue and all partners would need to be involved, encouraging the voluntary sector to seek national funding in addition to that received from the council.

The Corporate Director of Children and Education noted a York led bid had secured £500,000 for care leavers that will come into the system to trial a new approach which is having a clinical psychologist and six Advanced Clinical Practitioner Apprentices across the authority. He encouraged partners to look toward innovative models that possibly do not currently exist.

The Chief Executive, York CVS stated that there should be a management of expectations towards seeking funds outside York – places like the National Trust are closing their doors and there is fierce competion for funding from places like the National Lottery.

Resolved:   That the board noted the report.

Reason:      The report detailed the current provision and plans to deliver against priorities and the gaps that need to be addressed to improve outcomes for children and young people.