Executive	16 March 2023
Report of the Corporate Director of Adult Social Care and Integration

Children’s Mental Health – Review

Purpose

1. This is an update report following a member scrutiny review (Annex 1) that was presented to the CEC scrutiny meeting in May 2022. The Scrutiny Task Group highlighted several areas for consideration and improvement.

Background

2. Following the recent CQC Inspection and subsequent discussion at Scrutiny in May 2022, the council has worked closely with health and wellbeing partners to put in place several different interventions that support children and young people’s mental health – with a focus on early intervention to prevent crisis later.

3. Commissioners across Health and Social Care have been working with providers to continuously improve Mental health services across children and young people’s services.

4. We have embedded the i-thrive model across mental health commissioning ensuring that services that are commissioned support early intervention approaches, focussing on emotional and psychological wellbeing approaches that are evidenced based.  

5. To better understand how children and younger people’s mental health post-covid, during 2022 Public Health colleagues completed a schools survey asking children and young people about how they were feeling and specific questions around mental health as well as emotional and psychological wellbeing.

6. Using evidence gained through this survey and recommendations put forward from a CQC inspection, TEWV have completed an improvement plan alongside a clear action plan – including

· Improved early intervention and prevention services,

· Improve and extending access to mental health services joining up commissioning to reduce duplication

· System approach to trauma informed care

· Effective management of risk

· Improve levels of engagement and co-production with Children and young people

· Workforce development and integrated delivery where possible

7. TEWV have recruited a new Operations Director for York and surroundings areas who is working closely with health and social care commissioners as well as other providers and operational teams to continuously improve mental health services, specifically CAMHs.

8. A Children’s and Young People Mental Health Leadership Delivery Group (CYPMHLG) comprises of several partners including the Integrated Care Partnership (ICS), Community and Voluntary Sector and Public Health involved in commissioning, assessment, and delivery has been established. This group is specifically overseeing the delivery of the Children and Young People (CYP) Long-Term Plan and mental health pathways and a clear communication plan. The group will also ensure services being delivered in York continually improve.

9. The ICS are working with TEWV through its contractual processes to reduce assessment waiting times in CAMHs as well as ensuring referrals into services are sign posted to the right service. Work is ongoing with schools and primary care around right referral pathways into the right services.

10. Following evidence collected through the school’s survey as well as data from the population hub, commissioners can get a better understanding of need. Data clearly showed gaps in access to services for children seeking psychological support from the ages of 12yrs upwards.

11. As a result of identifying this gap, from September 2022 the Council working closely with the ICS at Place level and community voluntary sector providers commissioned counselling and wellbeing services for 12yrs-19yrs and 19yrs -25yrs. This service has been received well and more than 60 children have accessed counselling hours with others accessing digital online modules. These services enable young people to access the right service at the right time reducing inappropriate referrals in CAMHs, whilst providing essential services for younger people seeking psychological support.

12. Work is ongoing to deliver the CYP Mental Health Plan and the Council has appointed an All-age Head of Commissioning and Contracting with significant experience of commissioning across children’s, transitions (through school and into adulthood) and adults to ensure timescales for delivery is met.

13. Further work with Nimbus Care to provide a digital offer for GPs to refer families to if there are concerns regarding a young person’s mental health is ongoing.

14. The CYPMHLG is also working with key partners to develop joined up performance dashboards, this will enable a whole system approach to delivery and have early sight of the evidence and data to understand gaps in delivery.

15. Through the i-thrive model, Health and Social care commissioners are looking to continue to invest in early intervention and prevention services, enabling young people and families to access getting help and getting more services at the right time and the right place to reduce deterioration in the younger person’s mental health and wellbeing. The i-thrive model specifically builds on early support to reduce the need for crisis intervention.

16. In May 2022 the CEC scrutiny made several recommendations and the following provides an update on each recommendation together with achievements over the last 9 months:

Update on Scrutiny Recommendations

Recommendation 1

Completion of a joined-up data set of information for Children and Young People within SEND and Mental health services.

· The Council continues to work closely with partners, we now have a joint SEND dashboard in place that captures information on children and young people across health and care service.

· There is a dynamic support register across adults and children’s and ongoing conversations are being had to ensure a seamless approach to the dynamic support register, specifically around transitions. This is led by ICS colleagues and further work will progress to ensure whole system access. 

· Through the CYPMHLG partners are exploring building joined up mental health performance dashboards enabling sharing of information around service delivery as well as informing future commissioning decisions.

Recommendation 2

Executive Members work with the newly formed ICB and ICS, TEWV, CAMHS and council officers in public health as well as any other relevant bodies to implement a common child reference number system across all services in York.

· NHS numbers are frequently used to identify a young person across the health and social care system.

· Work is ongoing regarding a single care record that will support the system across primary care secondary care and the local authority. This work is being led on a HNY level through the ICB digital programme.

Recommendation 3

The Executive Member for Children, Young People and Education explores investing in early help, prevention services and peer support interventions, as recommended by participants at the joint scrutiny review such as the York Mind Project to develop a website for good self-help.

· There has been further investment into early help and prevention services with York Mind.

· Further work is ongoing to support the further enhancement of peer support.

· Work has also begun to build on the current York Mind web? project. There are a range of digital guides available on the website for young people to access as well as face to face meeting.

Recommendation 4

The Executive Member for Children, Young People and Education works with commissioners to support enhancing and redesigning pathways, investing in opportunities to commission services that would reduce the ‘bottle neck’ when children report mental ill-health and have to wait for long periods without support before it is made available to them. (This could be done by providing financial support to CAMHS, School Wellbeing Service and York Mind Counselling services.)

· Commissioners have worked closely with the Portfolio Lead Member for children services and the Portfolio Lead Member for adults to ensure early intervention mental health services are commissioned to support children and young people. 

· Due to gaps in available provision additional referrals into CAMHs resulted in some of the delays on waiting list. Following this analysis and building on the Public Health schools survey, health and social care commissioners have commissioned a 12ys-19yrs and 19-25yrs service to support children and young people to access the right support at the right time. This service supports children and young people access services for psychological and emotional wellbeing. The service assesses young people’s needs and offers a bespoke service.

· Since September this service has provided over 485hrs of counselling to 60 young people. The service will run for two years, and we will continue to monitor on a quarterly basis. Feedback from young people using the service has been positive and many referrals into the system have been through friends and family. the council is committed to support early intervention and prevention services that result in improve outcomes for our children and young people

· The ICS continues to work with TEWV regarding waiting list reduction, and have been successful in additional bids to support more schools with the mental health in schools’ service

· The Council continues to work closely with the ICB commissioning leads both regionally and through the York Place Partnership to support joined up commissioning and delivery approaches.

Recommendation 5

That CYC’s representative on the ICB makes the case for significant investment in Children’s Mental Health Services in York building on the i-thrive Model.

· The Head of All-age Commissioning is part of the Joint Commissioning Board that’s supports the Commissioning of Health Services locally. He will be leading on the implementation of the CYPMH plan alongside the ICS children and young people ICS commissioner. This plan builds on the i-thrive Model which focuses on early intervention to prevent crisis later on.

· The Corporate Director of Adults and Integration and Corporate Director of Children and Education met with the TEVW Director of Operations to ensure that services are delivered using population data and which are relevant to the needs of York.

· We continue to work with regional ICS partners to ensure that the population of York are clearly sighted within future investment planning based on informed data.

Recommendation 6

In partnership with relevant stakeholders, CYC will develop a Children’s Mental Health Plan for York, as part of the development of an All-Age Mental Health Strategy for York.  The All-Age Mental Health Strategy recognises the importance of parental mental health on the well-being of the child.

· A Mental Health Delivery Plan is being finalised and will be agreed through the CYPMHLG.  This plan will cover an All-age Mental Health Strategy.

· The strategy will be co-produced with children and young people and their families as well as adults. Work will begin on this in the new financial year with updates presented in line with governance process

Council Plan 2019 - 2023

17. The update on the recommendations put forward in the May 2022 report will meet the aims of the Council Plan which are to improve the quality of life for residents by supporting good health and well-being and by providing a better start for Children and Young People in York.

Implications – None at this stage.

Human Resources (HR) – None

Equalities - An EIA (Equalities Impact Assessment) to follow.

Legal – None

Information Technology (IT) – None

Crime & Disorder – None

Sustainability – None

Risk Management – None at this stage.

Recommendations

The Executive is asked to consider the Scrutiny Committee’s recommendations (set out in Annex 1), taking into account the update given against those recommendations in this report and noting the progress made so far. The council will continue to further develop joint partnerships and seamless services to ensure early intervention and prevention is embedded in practice as well as commissioning strategies.

Contact Details

Author: Jamaila Hussain Corporate Director of Adult Social Care and Integration Jamaila.hussain@york.gov.uk	Chief Officer Responsible for the report: Jamaila Hussain Corporate Director of Adult Social Care and Integration Jamaila.hussain@york.gov.uk
	Report Approved ü	Date	07/03/2023

Wards Affected:	All	ü
For further information please contact the author of the report.

Background Papers

none

Annexes

Annex 1     Children, Education and Communities Policy and Scrutiny Committee Scrutiny Report: Children’s Mental Health – Review of Referral System  

Abbreviations:

CYP                     Children and Young People

CAMHS               Children and Adolescent Mental Health Service

TEWV                  Tees Esk Wear Valley

VCS                     Voluntary and Community Sector

ICS                       Integrated Care System

CYPMHLG          Children and Young People Mental Health Leadership Group