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Health and Wellbeing Board |
25 September 2024
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Report of the Humber and North Yorkshire Integrated Care Board. |
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Children and Young People's Health
Summary
1. 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.
Background
2. In York, the number of children and young people (age 0-19yrs) equate to around a fifth (21.7%) of our population, but they are 100% of our future. Children and young people are the workforce of the 2020's and 2030's. They are the parents of the next generation. We have a responsibility to make sure all children and young people have what they need right now, and in the future.
3. The right to grow and develop, to have access to good quality health care and education are among just a few of all children's rights (United Nations Rights of the Child). Our legal duties to provide them are laid out in numerous Acts including Children and Families Act, Health and Social Care Act and Working Together to Safeguard Children Act.
4. There is also a fiscal case as we know that countries that invest in child health gain impressive economic rewards, with each £1 spent on children’s health returning over £10 to society over a lifetime. The converse is that poor health in childhood leads to reduced workforce participation and productivity and lowers national wealth.
5. Improving the health of children and young people is a key priority across all our strategies and plans, which are set out at paragraphs 13-19 below. Key is the Humber and North Yorkshire Integrated Care Board Integrated Strategy for Wellbeing, Health and Care that includes the “Golden Ambition” to drive a generational change for the wellbeing, health and care of our children, including:
· Prevention and early intervention: asthma, dental health, improved data.
· Learning well: speech and language support.
· Emotional resilience and mental health: enabling resilience and meeting need early, equity of access and reduced waiting times and improved crisis care to prevent admission to inpatient services.
· Care experienced children and young people.
6. This Golden Ambition is delivered through the Humber and North Yorkshire Start Well Board, which has members from system partners across the Integrated Care Board, including local authority and public health in addition to health commissioners and providers (please refer to the Glossary for abbreviations in diagrams):
7. The remainder of this report outlines how Integrated Care Board partners work to deliver these priorities.
Children and Young People's Mental Health
8. The Integrated Care Board Children and Young People’s Mental Health Strategic plan 2021 – 2024 aims to drive improvement across the national Thrive Framework for children and young people's Mental Health.
9. The current priorities, which aim to build on local Place priorities are listed below. Work is underway to produce a new system wide 3 year forward plan that builds on this current work and addresses new, emerging issues such as new forms of eating disorder. The new forward plan will focus on need and capacity in the system to meet it. It will also undertake a gap analysis and identify priorities for funding moving forward to improve access, waiting times and outcomes.
a. Improved prevention and early intervention to help people stay healthy and reduce demand on clinical services:
In York there is the universal offer of the School Well-being Service in all schools, jointly funded by the Integrated Care Board and City of York Council. There are now two Mental Health Support Teams (Well-Being in Mind) in targeted schools, those with links to areas of higher deprivation. Short term funding supports an emotional intervention model for York Mind. However, consideration needs to be given as to how this is sustained to develop a mixed model of delivery including counselling, social prescribing and groupwork is essential to build on existing provision and meet need, intervene early and reduce need for clinical services. Capacity is currently insufficient, with increased levels of need and longer waiting times to access support since the pandemic and holding higher levels of acuity with increased pressure on all children and young people’s mental health services including specialist children and adolescent mental health service. Additional investment to increase capacity in early intervention services and reduce need for clinical intervention has not been possible due to the significant financial challenges faced by the Integrated Care Board. In 2024/2025 service development funding is likely to be available to develop an improved offer in the child and adolescent mental health services single point of access but the financial position continues to have a bearing on this.
b. Improved/Expanded access to Mental Health services for those who need them:
In York there is Integrated Care Board funding into the Youth Justice Service (enabling provision of a speech and language therapist and a child and adolescent mental health services practitioner), alongside funding for the Together We Can offer for children and young people in or at the edge of care: this funding supports speech and language and psychology support. This year, the Integrated Care Board has approved a care leavers mental health project led by the six directors of children’s services in partnership with the Mental Health and Learning Disability Collaborative. This project will embed improved mental health support for care leavers in all six leaving care teams through a hub and spoke model of delivery. This will test a new model of care to improve access, enable early intervention, reduce clinical need and improve efficiencies and outcomes. Funding for care leavers across the Integrated Care Board that includes free prescriptions, eye tests and dental care has also been secured. At Integrated Care Board level, work continues to develop a single map and provision statement for children in care and care leavers. LGBTQ+ children and young people and ethnic minoritised young people are an identified priority inclusion group in line with Core20Plus5. Work with children and young people from these communities will result in several animations capturing lived experience which can be used as a training resource.
A Humber and North Yorkshire Task and Finish Group is working to improve processes to ensure seamless transition from children and young people to adult services – needs led not age led in line with the National Institute for Health and Care Excellence Quality Standards and the National Health Service England key lines of inquiry.
A children and young people mental health data dashboard has been developed which is able to provide accurate and timely data at a system and place level to evidence access, waiting times and outcomes. This will inform levels of need to help plan future provision. At present the national data is still based on previous Vale of York Clinical Commissioning Group footprint but from the end of October 2024 we will have accurate data for City of York.
c. Systems Approach to Trauma Informed Care.
Trauma-informed practice is an approach to health and care interventions which is grounded in the understanding that trauma exposure can impact an individual’s neurological, biological, psychological, and social development. This programme aims to work across the system to develop and embed a trauma informed approach across all organisations working with children and young people so that it becomes business as usual. This includes the following stakeholders:
The delivery of the multi-agency Attachment, Regulatory and Competency training across the whole Integrated Care Board area by our Framework of Trainers is going well, along with Champions training to embed training in organisations through a train the trainer model as well as training for Senior Leaders. Community of Practice meetings along with a toolkit provide ongoing support to organisations to embed this work in policy and processes with 127 people and 44 organisations being involved in them.
d. Effective management of risk.
Work is underway to develop a children and young people mental health specific suicide prevention plan which will include work to pilot a “waiting well” offer to ensure those waiting for child and adolescent mental health services are supported and issues do not escalate. The Integrated Care Board is working in partnership with the Humber and North Yorkshire Inpatient provider collaborative to develop an implementation plan for the new National Health Service England Inpatient Commissioning Guidance which aims to improve the offer in the community to reduce the need for admissions. The recent opening of the Willow Suite at Mill Lodge child and adolescent mental health services inpatient unit in York has 8 'day beds' which enables more children and young people to be treated, for eating disorders whilst remaining at home, reducing distress and facilitating earlier recovery.
The child and adolescent mental health services eating disorder home treatment service is now operational in York, supporting return to regular eating for children and young people in the care of the community eating disorder team to reduce need for admission. Risk remains a significant concern: the child and adolescent mental health services community crisis team lacks capacity whilst acuity in child and adolescent mental health services community service remains challenging for some children and young people.
e. Improved engagement and coproduction with Children and Young People.
The Humber and North Yorkshire Integrated Care Board Engagement and Coproduction Manager has worked with system partners to develop an ICB children and young people's engagement and coproduction strategy based on the national Lundy model which is being finalised. This will support partners to provide a consistent and evidence-based approach to engagement and coproduction. Communities of practice will be established to support Place to embed this. The Coproduction manager worked with Nothing About Us Without Us, the children and young people's mental health advisory group to hold a successful system wide event in York in August 2024 to bring together senior system leaders and co-produce solutions to the 50 recommendations raised by children and young people in recent consultations around design and delivery of emotional and mental health support.
f. Workforce Development.
In 2024, work continues to map current mental health staffing across the system and to develop an Integrated Care Board plan to deliver against the national National Health Service England Workforce Plan. This plan has been coproduced with partners across the system and will be implemented over the next year to deliver improvements against the priorities of recruit, retain, reform and train staff. This is intended to ensure we have a workforce that possesses the skills required to meet need and reflect our diverse communities across all National Health Service funded children and young people's mental health services.
Children and Young People's Physical Health
The Children & Young people's system wide transformation programme has a developing portfolio that incorporates the broader expectations around integration of services and addressing health inequalities. It provides strategic leadership, direction and support to services and organisations which support children and young people with long term conditions including epilepsy, asthma, and diabetes in line with the national National Health Service Core20Plus5 programme. The children and young people's transformation programme has governed this work through a system wide alliance, which is a collaboration of provider and partner organisations across health, local authority and the voluntary, community and social enterprise sector.
10. The transformation programme has developed and continues to support the clinical networks for children and young people with long term conditions. The purpose is to network, advise and support clinicians with implementing guidance and policy.
11. The programme includes projects funded by National Health Service England for children and young people with long term conditions such as an epilepsy psychology pilot and asthma pilot that are given as examples below. These pilot projects are delivered by clinicians embedded within practice with support and oversight by transformation programme to deliver seamless delivery of the National Health Service England deliverables.
a. Asthma:
Risk stratification has been undertaken and identified those children and young people in York who need urgent review of treatment due to the high number of inhalers prescribed. Appropriate triage and clinical input have been arranged for these children and young people. Primary care records and community diagnostics are being considered and proposals are underway to support diagnosis of children and young people with likely asthma. This includes ongoing work with Community Diagnostic Centres leads to understand the capacity, demand and workforce for children and young people asthma diagnostics across Humber and North Yorkshire. The modelling will evaluate solutions to improving access to diagnostic testing. Improvements to inhaler prescribing have also been introduced.
Plans are underway for an Asthma Friendly Schools nurse post to work in partnership with schools in York, public health, primary care and the specialist respiratory team in secondary care to ensure support is available and suitable to enable children and young people to fully participate in school life and that their asthma is managed safely and proactively. This commences in January 2025 and is funded from the York Health and Care Partnership health inequalities fund and aims to support young people to fully participate in school.
b. Epilepsy:
Approximately one third of children and young people with epilepsy have a co-morbid mental health disorder. A time limited pilot will deliver:
· Children and young people epilepsy services across the Integrated Care Board are now able to undertake mental health screening and children and young people in York have bespoke access to specialist psychology support if any needs are identified.
· Clinical epilepsy network and epilepsy peer review network supported by the Integrated Care Board Transformation programme, and a gap analysis is underway across the Integrated Care Board Integrated Care Board against the National Health Service England 'Epilepsy bundle' which outlines the standards of epilepsy care and outlines key recommendations for systems to consider.
c. Diabetes:
The diabetes component of the programme has rolled out a poverty proofing approach to support children and young people in York. This approach was originally developed in Hull and Grimsby and learning from this has been incorporated into local practice with a focus on the uptake of technology to manage the disease. This is the optimal treatment and reduces complications in the short and longer term as children grow up.
d. Healthier Together website:
The Integrated Care Board has developed a new website dedicated to children and young people's health, providing advice and information including locally produced resources and advice on a range of health conditions to encourage attendance at the right place first time. In addition, it provides social and public health signposting on the basis of making each contact count, and health information, support and resources for chronic conditions. Professional pathways and resources are also provided publicly on the site to encourage transparency and consistency. A children and young people's facing website will be a requirement of Integrated Care Boards going forward. Clinical leadership develops specific content in relation to current issues and seasonal advice and advice is also linked to local services at place and also programmes such as mental health.
e. Speech, Language and Communication transformation.
Improving the universal and targeted offer in relation to speech and language therapy and occupational therapy sensory processing advice is a priority for the Integrated Care Board. There is no easy solution, particularly in relation to the reducing workforce to support expansion and therefore alternative models are required.
Given the capacity challenges and concern about adverse outcomes in relation to long waits, a helpline has been set up where a 'concerned person' (teacher, social worker, parent/carer) can get direct advice from a Speech and Language therapist without need to submit a paper referral. This has resulted in 25-30% of the 'referrals/ discussions' being signposted to more appropriate support /advice provided on how to support children and young people with universal or targeted services.
The speech and language therapy teams have developed a suite of training sessions based on feedback from schools/settings on greatest need and from reviewing the referral reasons.
The service has just concluded a 'summer of speech' where they have focused on those children and young people who have been waiting the longest. They have contacted 314 children and young people /families on the waiting list and undertaken impact-based questionnaires to determine current need and implement appropriate programme of care or discharge as appropriate.
f. Occupational Therapy transformation.
The Occupational Therapy team have been developing a new service 'Let's Make Sense Together' approach and resources to support this service, and this will be launched in January 2025. This will see a similar approach to the speech and language advice line and will benefit from locally made videos and resource packs to support children and young people with sensory processing differences. This has been developed in coproduction with Parent Carer Forum and various stakeholders including special educational need colleagues, National Health ServiceEngland and representation from some schools/settings.
Strategic Plans
12. The Humber and North Yorkshire Integrated Care Board Integrated Strategy for Wellbeing, Health and Care includes the “golden ambition” to drive a generational change for the wellbeing, health and care of our children. This Golden Ambition is delivered through the Humber and North Yorkshire Start Well Board, as well as through place-based partnerships to drive forward plans to transform services.
13. Work is also underway to address health inequalities using the national Core20Plus5 framework which works across physical and mental health.
14. A priority for York Health and Care Partnership Executive Committee and reflected in the 2024 Annual Report and Joint Forward Plan is to develop a partnership based, inclusive model for children, young people and families. The aim is that children are at the centre of our city life, and work is done in partnership to raise a healthy generation of children. In July the Health and Wellbeing Board members received a presentation about the work undertaken by the partnership.
15. One City, for all, the City of York Council's Plan (2023-2027), sets a strong ambition to increase opportunities for everyone living in York to live healthy and fulfilling lives. It states: "we want every child to be safe, healthy, and happy in strong resilient families, living in diverse inclusive communities, with equal opportunities to ensure they achieve their full potential and the best possible outcomes".
16. Our work at place and across the system also aims to deliver health and wellbeing priorities of the York Children and Young People’s Plan, with health a priority.
17. There are several boards, committees and partnership arrangements in York where children and young people are the sole focus of the boards work, and some where children and young people are part of an all-age Board.
18. There is further work to be done to integrate
our arrangements as commissioners which will help to facilitate
integration between providers of health, care and education which
benefits all of our children, young people, and families,
particularly those in greatest need.
Implications
Financial: there are no financial implications
Human Resources (HR): there are no HR implications: there are general references to workforce development as a priority across the Integrated Care Board.
Equalities: matters of equalities are referenced in the report, in relation to minoritised communities and LGBTQ+ children and young people
Legal: there are no legal implications: there are general references to statutory duties within the report.
Crime and Disorder: there are no implications for crime and disorder
Information Technology (IT): there are no IT implications
Property: there are no property implications
Other: None identified
Risk Management:
19.This report makes clear that there is ambition and commitment to ensure that the health and well-being of our children and young people is secured and prioritised in planning and delivery. However, there has to be a realistic assessment of the wider context within which public sector currently operates and its impact on children and young people, in particular funding and the reduction in staffing resources as significant numbers of clinical and support staff have exited since 2020 and fewer are coming through training.
20.These are inter-related and present challenges for how all York partners work together. We have some excellent examples that demonstrate the work progressing to inform and shape the future of health provision, including the Mental Health Support Teams in schools, the transformation of speech, language and communication services, the 'Making Sense Together' films for the universal occupational therapy offer and the schools asthma project.
Recommendations
21.The Health and Wellbeing Board are asked to:
1. Note the current provision and future plans to deliver against priorities and the gaps that need to be addressed to improve outcomes for children and young people;
Contact Details
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Gail Teasdale: Programme Lead for Children and Young People's Mental Health, Humber and North Yorkshire Integrated Care Board (Humber and North Yorkshire Integrated Care Board)
Louise Wootton: Senior Quality Lead for Children and Young People in York, Humber and North Yorkshire Integrated Care Board
Susan De Val: Senior Commissioning Manager Children and Young People Humber and North Yorkshire Integrated Care Board |
Chief Officer Responsible for the report: Sarah Coltman-Lovell, National Health service Place Director
Report Approved
Date: 10.9.24
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Wards Affected |
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Annexes
Annex A: Extract from York Health and Care Partnership Report and joint Forward Plan (May 2024) Annex A - YHCP annual report and joint forward plan final May 2024.pdf (york.gov.uk).
Glossary of Abbreviations
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CAMHS |
Children and adolescent mental health service |
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CYP |
Children and young people |
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HNY |
Humber and North Yorkshire |
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ICB |
Integrated Care Board |
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ICP |
Integrated Care Partnership |
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ICS |
Integrated Care System |
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NHS |
National Health Service |
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VCSE |
Voluntary community and social enterprise |
Background Papers
· York Health and Care Partnership Report and joint Forward Plan (May 2024) Annex A - YHCP annual report and joint forward plan final May 2024.pdf (york.gov.uk).
· York Health and Care Partnership Report and joint Forward Plan (May 2024) Annex A - YHCP annual report and joint forward plan final May 2024.pdf (york.gov.uk).
· York Children and Young People’s Plan - Children and Young People's Plan – City of York Council
· Humber and North Yorkshire Children and Young Peoples Mental Health Strategic Plan (2021 – 2024) Humber-and-North-Yorkshire-HCP-Children-and-Young-Peoples-Mental-Health-Strategic-plan-2021-2024-FINAL-.pdf (humberandnorthyorkshire.org.uk)
· Humber and North Yorkshire Children and Young Peoples Trauma Informed Care Programme - Children and Young People’s Trauma Informed Care Programme - Humber and North Yorkshire Health and Care Partnership
· Health Inequalities – NHS England » Core20PLUS5 infographic – Children and young people