Agenda item

To receive a presentation from the County’s representative from the Child and Adolescent Mental Health Services (CAMHs).

The Chairman welcomed Chris Martin (Integrated Commissioning Director (West)) and Christina Pace (Commissioning Lead, Essex County Council) to the meeting. They were representing the Child and Adolescent Mental Health Services (CAMHS) and were there to give a presentation on the joint re-commissioning of emotional well being and mental health services for Children and Young People in Southend, Essex and Thurrock.

The Committee noted that the current services were delivered by a range of different organisations operating under multiple contracts, causing issues about access and consistency.

Now with national government plans to put in more funding, their new service model will be based on needs assessment and feedback from consultation with service users and partners. This highlighted the need for more integration and clearer access routes to services, especially for vulnerable people and for the consistency of the quality of service.

They were jointly commissioning one integrated service for the whole county for targeted and specialist mental health services. Any specialist services were to be integrated with this one service in order to meet demand and to support this universal service. There would be a single point of access for all referrals to the service, including self referrals. The services would be community based and available in each area. They would focus on identifying and treating young people who need CAMHS services as early and effectively as possible.

There would be a focus on outcomes, the new service to demonstrate how young people’s outcomes would be improved and to enable young people to set their own goals for improvement. Young people would be engaged each step of the way, in developing models, evaluating bids, in feedback on their experiences of treatment and in influencing service development.

There would be a single point of access with a single contact number. There would be better and clearer pathways into the services needed; a more holistic support service. There would be 24/7 access to the crisis services and a community based intervention service. There would also be consistent advice and training for all their partners.

The new style services provided should provide improved emotional wellbeing, and resilience and self-esteem for children and young people, their families and carers. It would provide easier access to services with a timely response.  Families and carers would be appropriately supported; and there would be reduced inappropriate use of A&E to access mental health services.

They hoped to evaluate the final bids by the end of May and identify the successful bidder. From June to November they would be working with the successful bidder of the new service, the commissioners and the stakeholders to plan the transition to the new service. By November 2015 they would be ‘going live’ with the new service.

It was noted that a new national taskforce had recently made recommendations on improving mental health for children and families and nationally, an additional £1.25 billion investment over a five year period was set out in the budget. CAMHS were uncertain how any future government would respond, but this was an opportunity to build on their new service model.

The meeting was then opened out to questions from members.

Councillor Surtees said he had experienced long delays in getting services to children, but once there the progress was fast and effective. Would this become better with the new service? He was told that they were sorry for the delays he had experienced; the new service model had clear expectations on time and the services provided.

Councillor Murray thanked them for their presentation. He noted that a recent joint BBC and Community Care Journal investigation into mental health trusts found real cuts in budgets. How was your new scheme affected by these cuts? He was told that the study was referring to all mental health services and they could not comment on the affect on the adult mental health services. Although there was no extra money available they would not be taking out any money from our services. They were now also using what they have more effectively and were designing a more flexible and responsive services led by what the young people told us about what they want. Councillor Murray commented that he had listened to the comments about the additional funding, but you had to be very careful about this. Mental Health has gone up the political agenda, but what had been announced may not be what was delivered.

Councillor Watts said that he had no idea who their bidders were. Were they public or private bodies, and what would they be providing? Also what ages do you cover, and what happens when a young person gets to old? Ms Pace said that they covered young people from 0 to 18 years old and up to 25 for people with special needs and disabilities. They would then facilitate a transition up to the adult mental health services. When they were moved would depend on their status, such as if they were looked after children, then the clinical commissioning groups here would retain responsibility for commissioning services for those children and to make sure they get proper support from the local services. They expected a good standard of care on transfer. She was limited in what she could say about who the bidders were as they were in the middle of a procurement process. However, there were three foundation trusts bidding to provide their services, all with long experience of providing child and adolescent mental health services. Councillor Watts was not satisfied with the answer and asked if they ensured what processes were in place. He was told that the processes for a youth that was moving depended on their individual circumstances. They could reassure him that any mental health trust working with young people would have a robust process in place for the transfer of care. Transition was one of the areas where they could have a richer dialogue with providers asking them what their expectations were. This would also inform their decision on who the best bidder would be.

Councillor Janet Whitehouse asked if the speakers could provide a few examples of how this all worked, bring it down to the experience of an individual child. It has been mentioned about having antiquated systems. Could you give examples of a young person who referrers themselves, what would happen on the way and what the outcome would be? She was given an example of a young person who had anxiety but did not need urgent treatment. Now, they could be referred by schools or parents or a GP. In the future they could refer themselves via the website or call and speak to someone. Now they would have to wait to be assessed and spend time on a waiting list. But in the future they hoped their initial case would be screened more quickly and they would get better, clearer information back, more quickly, about what would be offered to them, such as what support or counselling that could be accessed at school or at a GP surgery. When they get that support they can say what they wanted from it. They could have a conversation with their counsellor about their concerns and needs. At the end of every session they could then feedback on how it was working for them. They could do this confidentially as there would be different ways to do this. Councillor Whitehouse then asked if there would be a greater number of counsellors to be able to get this quick response. And who would these counsellors be and where would they come from. She was told that they would be trained clinicians from different backgrounds, some from our own staff transferring to the successful bidder and staff from existing mental health trusts. The successful bidder would be using the existing workforce but offering them existing training opportunities and different ways of using that workforce to provide that support.

Councillor Chambers asked how they would integrate services for young people with disabilities. Ms Pace replied that they wanted good joint working to provide integrated support and to use integrated planning methods, but were still testing this out.

Councillor Sartin asked about the existing staff who were currently employed by them and the NHS, where would they be working from. Essex was a large geographical area and there would be a need to have the right staff in the right places. How could you ensure that? You also referred to new training for the likes of teachers etc. who would provide that relevant training? She was told that they required in their specifications, good coverage in all areas, but that was a big ask as they covered Essex, Southend and Thurrock. This covered 7 clinical commissioning group areas. They were asking for community based teams to be available in the 7 clinical commissioning group areas. They asked for community based outreach focus within these areas and expected them to provide good outreach services. As for training they have asked for the new service to provide better training, advice and consultations to a range of partners as we felt this was important; enabling other partners to work better with children, young people and their emotional needs. Bidders are to tell us the details of how they would deliver this. They would expect them to cover identification (of needs), provide low level safe support and how to refer effectively for high level support. This bidder would be providing just one service across the 10 partners. That would, by its nature deliver more flexibility around how we covered the patch. This would be one provider across that patch as opposed to the several as it was now.  Also the difference would be that the young people would be at the heart of the service we provided.  One of the key elements was that it was based on feedback.

Councillor Wixley asked how many children and adolescents required help and what was the number employed to carry out these services. Ms Pace said that in terms of need, it was a difficult area to quantify. Nationally, in the 1990’s about 10% of young people were in need, in Essex that would be about 40,000 young people.  As part of our bidding process we asked each bidder to provide figures so we could evaluate them.

Councillor Jon Whitehouse asked about the waiting time for services and the criteria for referral. At least one local primary school had expressed concerns that the criteria published by CAMHS for referrals were not being kept to and in practice a higher threshold was being applied. Therefore leaving the school to commission their own services (without the expertise that CAMHS has). Six months could be a long time for a child and would your new criteria change this. He was told that the criteria for the future would stay the same and would be applied consistently, targeting a range of mental health concerns. This would be as published in the Essex gateway criteria.

Councillor Kane asked which body would collate the information and assess the success rate of the model. She was told that the new provider would provide the statistics to the West Essex Commissioning Group and each partner would be monitoring the outcome of the new providers.

The Chairman thanked Ms Pace and Mr Martin for their informative and interesting presentation and useful answers to the questions asked of them.