Agenda item

This item is expected to commence at approximately 14:00, following a break.

Purpose of the report: To review the implementation and performance of the new Emotional Wellbeing and Mental Health (EWMH) services for children and young people (CYP) in Surrey, which began operation in April 2021. The report specifically draws out the early intervention elements of the provision.

This report will provide information about the mobilisation of EWMH services and reflect upon the first six months of operation and what evidence there is of how the new services are beginning to improve outcomes for service users.

Witnesses:                                                     

Maureen Attewell, Deputy Cabinet Member for Children and Lifelong Learning

Hayley Connor, Director – Commissioning

Jessica Thom, Children’s Emotional Health Alliance Programme Director (Surrey and Borders Partnership NHS Foundation Trust)

Kerry Clarke, Children and Young People Head of Emotional Mental Health and Wellbeing Commissioning (Surrey Heartlands Clinical Commissioning Group)

Kate Scribbins, Chief Executive Officer, Healthwatch Surrey

Katharine Newman, Intelligence Officer, Healthwatch Surrey

Also in attendance:

Bernadette Muir, Chairman of the Adults and Health Select Committee

Angela Goodwin, Vice-Chairman of the Adults and Health Select Committee

Key points raised during the discussion:

1.    A Vice-Chairman asked what the level of mental health need was for children and young people in Surrey and how new Emotional Wellbeing and Mental Health (EWMH) services would meet that need, what the key risks were and why the contract had been awarded for seven years with an option to extend for a further three.

2.    The Director – Commissioning explained that, following the COVID-19 pandemic, one in seven children nationally had an emotional or mental health need and the acuity of children and young people’s needs had also increased. The new service model did not assume that all children with such a need required a medical or therapeutic intervention; the alliance approach, focus on early intervention and THRIVE model were adopted to mobilise the entire system to respond to demand.

3.    Key risks included demand for services, staff recruitment and retention and managing the transition to the new way of working. A longer-term contract provided Alliance partners adequate time to implement new systems and ways of working and to recruit to services.

4.    The Chairman of the Adults and Health Select Committee (‘the A&H Chairman’) asked how the different members of the Alliance – which included organisations who were involved in Surrey’s previous Child and Adolescent Mental Health Services – would work together and for an overview of the Alliance’s governance arrangements.

5.    The Director – Commissioning explained that new leadership and enhanced accountability were provided through the introduction of the role of the Children’s Emotional Health Alliance Programme Director (‘the Programme Director’) to lead the Alliance’s partnership work and to ensure partners had an equal voice, the introduction of the role of the Children and Young People Head of Emotional Mental Health and Wellbeing Commissioning (‘the Head of EMHW Commissioning’) to focus on emotional wellbeing and mental health commissioning, and the council becoming the lead commissioner for emotional wellbeing and mental health services. The Surrey and Borders Partnership NHS Foundation Trust (‘SaBP’) had also introduced the new role of Executive Director for Children’s Community Services.

6.    The Executive Finance, Contracts, Quality and Performance Accountability Committee led on contract monitoring and delivery and was attended by the Director – Commissioning and Head of EMHW Commissioning, amongst others. The Director – Commissioning stated that with the introduction of a user voice and participation team, the voice of children and young people was ‘hardwired’ into the Alliance, which aimed to prioritise improving the experience of children and families as well as service performance. A young person with experience of service use had been recruited and was forming a shadow Alliance Board of young people and families to contribute to service delivery and development. The Alliance was open to changing and improving over the course of the contract. There were also a number of reference groups with key strategic partners. The Head of EMHW liaised with the Deputy Cabinet Member on a monthly basis and the Alliance reported to the Health and Wellbeing Board. The Surrey Safeguarding Children Partnership and the system-wide Strategic Mental Health Improvement Group received regular updates on the work of Alliance also.

7.    The A&H Chairman asked whether a performance dashboard was to be produced and whether a representative of a Select Committee could become involved in one of the reference groups. Performance dashboards were being developed and the A&H Chairman was invited to contact the Head of EMHW Commissioning regarding becoming involved in a reference group.

Liz Townsend left the meeting at 14.26

8.    A Vice-Chairman asked whether the work of third sector partners within the Alliance was fully funded or whether they were also reliant on other funding sources. The work of all partners was fully funded under the contract, but third sector partners did have access to other funding streams.

9.    The Vice-Chairman asked how confident the witnesses were that a resilient model of partnership working had been developed. The Director – Commissioning explained that the Alliance was based on a model first developed in Plymouth and related research; officers had experience of alliance/partnership working and were working to develop the partnership but cautioned that the contract was being mobilised in the context of a global pandemic and workforce and demand issues. She believed that the achievements made so far were a testament to the developing partnership, highlighting that 45 peer mentors were in place, nearly all of Surrey’s District and Borough Councils had a coordinator, and ten mental health support teams were to come online soon. The Programme Director added that the Alliance was building its relationships effectively and was supported by an external organisation in doing so.

10.A Member asked whether the witnesses could provide a clear overview of the structure of the Alliance and the responsibilities, accountability and relationships of its members. The Director – Commissioning responded that, in order to meet the level of demand in Surrey, it was necessary for a range of partners with a range of expertise to be involved in the delivery of EWMH services. The Alliance’s ‘robustly structured’ contract set out the accountability of partners and expectations in terms of their performance, including clear specifications, budget allocations, activity and outcomes. The Alliance’s vision and strategy, which were to be refreshed, drew the partnership together. Further, the Alliance was accountable to NHS England. Monitoring performance was connected with the governance structure. Supporting third sector partners to report to the NHS’s expectations had been a challenge.

11.The A&H Chairman asked how the Alliance would manage performance issues resulting from changes to demand and whether partner’s budgets could be revised in the future. The Director – Commissioning explained that the contract was constructed so as to enable funding to be allocated where required; over the course of the contract, the Alliance expected funding for more-intensive interventions to be redistributed to early intervention as the latter reduced demand for the former; however, this was made more challenging by the increase in children’s needs due to the COVID-19 pandemic. The Alliance was developing its collection of quality data to enable it to identify any bottlenecks and how demand in certain service areas could affect other services in the future. The Programme Director added that the THRIVE model not only related to how frontline services were delivered but also how professionals operated at all levels: for example, in light of significant pressures in the neurodevelopmental service area, the Alliance had convened to review the entire system to identify how capacity within it could be used to ameliorate those pressures. The Alliance was mindful that it was to deliver its contract within a financial envelope and that with time it would be able to better model future demand and subsequently reallocate funding or request further funding as necessary.

12.The A&H Chairman asked whether third sector members of the Alliance would receive additional funding if demand for their services increased significantly. The Director – Commissioning explained that there was a set amount of funding (circa £4m) for early intervention and an expectation that more funding would flow to early intervention over time. The Director emphasised the position of third sector providers as partners at the heart of the Alliance and explained that through data and demand monitoring, the Alliance would be able to make decisions in respect of resource allocation.

13.A Member asked how the Alliance would ensure that funding for early intervention would be used for that purpose. The Director – Commissioning explained that the Executive Finance, Contracts, Quality and Performance Accountability Committee would ensure funding was distributed appropriately. She highlighted significant progress in reducing some backlogs through improvements to how contacts were received and cases progressed under the new model. The Programme Director added that third sector partners had entered into a contractual agreement to form the Surrey Wellbeing Partnership within the Alliance and it was important to allow that partnership to make their case for additional funding if that was required and stated that how such conversations were handled and how priority areas requiring additional focus or resource, such as backlogs for assessment, were identified. The Head of EMHW Commissioning added that since the new services had become operational there has been a focus on backlog, the children with the greatest needs were seen in a timely way and the children who were waiting longer had less-severe needs and were at lower risk and were being supported by third sector partners.

14.The Member asked what independent external monitoring of the Alliance was undertaken. The Director – Commissioning stated that monitoring was improving under the new contract and would provide clearer understandings of progress and that the NHS had regional and national oversight of the Alliance and Ofsted had scrutinised services during focused visits.

15.A Vice-Chairman asked how third sector partners with differing practices would be supported to work together effectively, how the views and needs of stakeholders would be given due regard over the course of the contract, how members of the shadow Alliance Board would be recruited and how it would be ensured that shadow Board members represented the views of all relevant children and young people. The Director – Commissioning explained that the Surrey Wellbeing Partnership had recruited a chairperson and an executive director and resources were being invested to achieve consistency. There was a system convener for children, whose remit included ensuring the views and needs of children were at the heart of services and considered during codesign. The Programme Director commented that the Alliance needed to be cautious and ensure that young people’s contributions did reflect the whole population, including by supporting young people and providing them with structure and proactively engaging with them; an experienced participation lead was to be recruited to ensure engagement captured the views and needs of all of Surrey’s children and young people.

16.A Member asked how the Alliance worked with external organisations, such as public health partners, to support the maintenance of children and young people’s emotional wellbeing and mental health. The Director – Commissioning explained that such work formed part of the Health and Wellbeing Board’s agenda, the Assistant Director – Commissioning was a public health specialist, and the Alliance was to integrate further with the health system. The Alliance was able to connect with other organisations – the district and borough-based early intervention coordinators and reference groups would have good understandings of localities and relevant organisations.

17.The A&H Vice-Chairman asked how the Alliance interacted with the General Practice integrated Mental Health Service (GPiMHS) and primary care networks (PCNs) and how the Alliance’s work around transitions from children’s services to adult’s services connected with that of the council and NHS. The Director – Commissioning explained that the link with GPiMHS and PCNs was through the Alliance’s development of a transition service, which children and young people would be involved in codesigning; and the Alliance was connected with the council’s Preparation for Adulthood Programme.

18. The Chairman invited the representatives of Healthwatch Surrey to introduce themselves and their organisation. The Chief Executive Officer (CEO) explained that Healthwatch was an independent, statutory organisation with responsibility and statutory powers to ensure that the voices of both adult and child service users were heard across the NHS and social care by collecting feedback and insights to share with commissioners and providers. By acting as a critical friend, Healthwatch ensured that commissioners and providers had their own robust and inclusive user involvement and feedback mechanisms in place. The CEO explained that most of Healthwatch’s insights relevant to the topic related to the former Child and Adolescent Mental Health Services. The CEO recognised that Healthwatch was usually contacted when service users’ experience had been negative and, thus, that feedback was not entirely representative.

19.A Member asked if the witnesses had any initial reflections on the new EWMH services, what the key issues were for users of EWMH services, and if any risks were apparent to them. The CEO explained that Healthwatch was most interested in how user feedback mechanisms were structured, how user voice would be represented at every level, and how young people in advocacy roles would be supported to represent their peers. Looking ahead, Healthwatch was interested to observe how issues with the previous provision – including fragmented services, long waiting times, and thresholds for support – improved under the new services.

20.A Member asked if Healthwatch provided its feedback under a formal system. Healthwatch was connected with other user voice organisations and the CEO explained that Healthwatch was empowered by statute to require providers to respond to the issues it escalated, had certain expectations when escalating a ‘concerning case’ and monitored how providers responded to, and learnt from, such cases.

21.A Member asked how well the partnership alliance was communicating with children, young people, and their families regarding changes to service provision and the impact for them. TheIntelligence Officer explained that families were concerned whether the service provision would change or if it was just a ‘rebadging exercise’.  It was acknowledged that there were some people who had negative associations with the name CAMHs, and thus it was the appropriate time to change both the name and the approach from the services. The Deputy Cabinet Member explained that the name CAMHs had been maintained for the clinical aspect of services. 

22.The Chairman asked whether Healthwatch had been informed of the top-line performance measures put in place. The CEO explained that Healthwatch held a seat on the Health and Wellbeing Board and the Quality and Performance Board for Surrey Heartlands and, therefore, were sighted of performance measures.

23.A Member asked if there were any particular areas Healthwatch thought it would be useful for the council’s Select Committees to scrutinise. The CEO offered to provide a response after the meeting. 

Actions:

I.             Chief Executive Officer of Healthwatch Surrey to suggest to the Select Committee priorities for future scrutiny of children and young people’s Emotional Wellbeing and Mental Health services.

Recommendations:

1. The Select Committee agree an approach to future scrutiny of Emotional Wellbeing and Mental Health services with the Adults and Health Select Committee.

2. That the Director – Commissioning arrange the development of a dashboard of key performance information and make it available to the Children, Families, Lifelong Learning and Culture and Adults and Health Select Committees.

3. That the Director – Commissioning provide the Select Committee with a report containing a clear overview of the Alliance Partnership’s governance including further detail on the specific role of each organisation within the Partnership Alliance, the associated performance measures and targets and the resources allocated to them by April 2022.