Agenda item

Purpose of the item: To provide an update to Adults and Health Select Committee and the Children, Families, Lifelong Learning & Culture Select Committee on Children’s emotional wellbeing and mental health (EWMH) and the services provided in Surrey.

 

Witnesses:

Mark Nuti, Cabinet Member for Adults and Health

 

Sinead Mooney, Cabinet Member for Children, Families and Lifelong Learning

Clare Curran, Cabinet Member for Education & Learning

Maureen Attewell, Deputy Cabinet Member for Children and Families

Rachael Wardell, Executive Director for Children, Families and Lifelong Learning

Liz Bruce, Executive Director, Adult Social Care and Integrated Commissioning

Hayley Connor, Director for Commissioning, Children, Families, and Lifelong learning.

Kerry Clarke, Children and Young People (CYP) Head of Emotional, Mental Health & Wellbeing Commissioning

Lisa Andrews, Public Health Principal

Fadzai Tande, Assistant Director, Learning Disabilities and Autism (LDA) & Transition

Graham Wareham, Chief Executive, Surrey and Borders Partnership NHS Foundation Trust (SABP)

Trudy Mills, Executive Director for Children's Community Services, Surrey and Borders Partnership NHS Foundation Trust (SABP)

Jess Thom, Programme Director, Mindworks

Ann Kenney, Independent Chair of Surrey Wellbeing Partnership

Olivia Davenport – Assistant Manager for the User Voice and Participation Team

Ethan Brooke – User Voice and Participation Apprentice

 

Key points raised during the discussion:

 

1. The Chairman asked if bullying was dealt with at an early enough stage. The User Voice and Participation Team Apprentice confirmed that common feedback from young people included reports that schools did not take reports of bullying seriously enough and that colleges lacked bullying support.

 

2. The Chairman, in noting the low participation in Safe Havens, questioned the barriers to people attending and asked if more communications about the Safe Havens was required. The User Voice and Participation Team Apprentice confirmed that feedback had shown that some of those that would benefit from attending the Safe Havens found it difficult and expensive to travel to the existing locations and an Action Card had been raised to incorporate more locations as a result. The User Voice and Participation Team Apprentice agreed that wider communications could increase awareness.

 

3. A Member questioned how communications about the mental health support available for young people could be improved. The User Voice and Participation Team Apprentice said that awareness could be widened by having frequent and increased communications in schools and colleges.

 

4. A Member asked what travelling distance to Safe Havens would be appropriate as this could inform decisions about the number of Safe Havens required. The User Voice and Participation Team Apprentice was unsure of the appropriate distance but noted that cost of travel also impacted young people’s ability to attend the Safe Havens.

 

5. The Chairman asked what were the difficulties faced by young people with autism and mental health issues combined. The Assistant Manager for the User Voice and Participation Team UVP Team said that young people wanted their mental health and neurodevelopmental issues or disabilities to be considered holistically and as a whole. The User Voice and Participation Team Apprentice offered to share feedback to the Committee by email if required.

 

6. A Member queried the level of engagement with young people not in education, training or employment and asked what could be done to increase engagement with this cohort. The User Voice and Participation Team Apprentice said that services reaching out to these young people by text, phone or social media could be used to increase participation of this cohort.

 

7. The Cabinet Member for Children, Families and Lifelong Learning asked how the Action Card findings were reported back to schools and colleges. The User Voice and Participation Team Apprentice explained that the Action Cards in question were raised with participation groups rather than schools directly and communication also took place through the schools bulletin.

 

8. The Cabinet Member for Children, Families and Lifelong Learning asked how the reported lack of support in schools was fed back to them. The Executive Director for Children, Families and Lifelong Learning confirmed that the safeguarding partnership included maintained and independent schools and considered mental health and bullying safeguarding issues with leadership around these issues directed into all kinds of schooling in Surrey.

 

9. The Vice Chairman noted the omission of information about ethnic minorities accessing services and asked what support was on offer to them. The Assistant Manager for the User Voice and Participation Team said that ongoing surveys are distributed to children and young people to gain the voice of children and young people who do not attend participation groups. Surveys capture information on ethnicity. UVP have an aim for all participation groups to be representative.

 

Governance

 

10. The Vice Chairman asked in what respects did the THRIVE framework for system change and children’s mental health form the basis of the commissioning model. The Children and Young Person’s (CYP) Head of Emotional, Mental Health & Wellbeing Commissioning explained that the THRIVE model ensured that children were central to decisions about their needs and facilitated a move into working collectively to keep children thriving. The framework allowed needs to be identified, the appropriate timing of support and the consideration of children entering through hospitals or in crisis, providing appropriate and timely support based on need.

 

11. The Vice Chairman queried the effectiveness of the model and asked if effective delivery was anticipated. The CYP Head of Emotional, Mental Health & Wellbeing Commissioning confirmed that improvement had been seen with positive feedback received about the training provision and THRIVE champions and leads informing system change. THRIVE would take five years to embed and change was being seen. The Chairman asked if the training was mandatory and if the numbers of people undertaking the training were recorded. The CYP Head of Emotional, Mental Health & Wellbeing Commissioning explained that the training was not mandatory and although data was collected it was not comprehensive or brought together into one place at the moment.

 

12. The Vice Chairman asked what feedback about service delivery had been received from front line staff and what were the case numbers of front-line staff.

 

13. A Member, in referencing page 82 and the reporting outcomes and experiences happening from April 2023 asked why it had taken so long to compile metrics to demonstrate the effect of MindWorks. The Director for Commissioning, Children, Families, and Lifelong learning explained that work to bring data together from a number of partners to form a complete picture was ongoing and had resulted in information available about delivery and how many people were waiting for that delivery. The Member said that the report did not include evidence of reporting outcomes in respect of any of the services by MindWorks. The Programme Director, Mindworks said that partners had agreed to report on eight standard outcomes and the data had not been included in the report as it was currently being collected manually. The Chairman asked if the Mental Health Delivery Board had access to the manual data. The Programme Director, Mindworks confirmed that the data had been shared with the board and could be shared with the Committee. The Member asked for a timeline for the sharing of this data. The Cabinet Member for Children, Families and Lifelong Learning agreed that a succinct timeline was required and would be provided. The Chairman noted the urgency in delivery data to those that needed it. Action – The Cabinet Member for Children, Families and Lifelong Learning

 

14. The Chief Executive, Surrey and Borders Partnership NHS Foundation Trust committed to provide the committee with a summary document within a couple of weeks followed by an integrated outcome measure by April 2023 as outlined in the Select Committee report.

 

15. A Member, in noting number 7 of the Caldicott principles, asked how information would be consistently shared amongst those that needed it. The Chief Executive, Surrey and Borders Partnership NHS Foundation Trust confirmed the development of all systems currently in place to allow them to feed data using application programming interface (API) protocols into the Surrey Care Record. These developments would allow a mental health practitioner to access ‘System 1’, and view primary and secondary care documentation. In addition, work was happening to bring voluntary sector colleagues into the integrated health information systems. The Executive Director for Children's Community Services, Surrey and Borders Partnership NHS Foundation Trust added that voluntary partners and the leadership team had been involved in workshops to consider an overarching system to pull the data together and provide clear visibility of where a child had been receiving care.

 

16. A Member asked if patients would also have access to their records. The Executive Director for Children's Community Services, Surrey and Borders Partnership NHS Foundation Trust confirmed that a patient portal would be developed if the proposed platform developments were signed off. The CEO, SABP summarised the role of the patient app and the local and national implications of the app.

 

17. A Member in noting the repeated report expectation that “100 per cent of those on neurodivergent pathway get diagnosed within a year” asked how long it took on average on the neurodivergent pathway to receive treatment and would this timeline be considered good under the THRIVE model. The Executive Director for Children's Community Services, Surrey and Borders Partnership NHS Foundation Trust explained that the neurodiversity pathway was diagnostic with no treatment; rather reasonable adjustments, inclusion and strategies to allow the child to thrive. Data was available for how long children had waited for each element of the four-part NICE diagnosis and the ambition was to provide a diagnosis within 12 months.

 

18. The Chairman queried if a delay in diagnosis would affect schools due to the funding for staff. The Executive Director for Children, Families and Lifelong Learning explained that schools support of children yet to receive an Education Health and Care Plan (EHCP) was included in the ordinarily available provision and covered by the schools’ core funding. Schools with children experiencing delays to their ECHP may encounter a delay in the making arrangements for any additional provision, but the ordinarily available provision for children with additional needs should still always be available.

 

19. A Member was concerned about the lack of in person diagnoses. The Programme Director, Mindworks said that children would receive a face-to-face diagnosis in most cases and invited the Member to share the details of any circumstances where this was not case.

 

20. A Member questioned if measures were in place to ensure a late diagnosis would not result in a lack of support. The Programme Director, Mindworks recognised that this may occur and noted the local and national work around awareness which had resulted in an increase in demand.

 

21. A Member questioned how children and young people qualified for mental health support and asked how could earlier intervention take place. The Director for Commissioning, Children, Families, and Lifelong Learning said that the Mindworks contract had been set up to focus on early intervention and was set within a programme of intervention that included initiatives such as Healthy Schools.

 

22. A Member, in referring to the mention of suicide prevention for children and young people, in paragraph 47, page 80 of the report, asked how suicide prevention for this group operated and could suicide prevention be improved. The Public Health Principal summarised a developing suicide prevention strategy for children and young people within Surrey and noted that national guidance was expected to support further development.

 

23. The Chairman, in referencing item 36, page 77 asked for clarification about mental health support teams. The CYP Head of Emotional, Mental Health & Wellbeing Commissioning confirmed that a mental health support team would be located in clusters of schools, based on an evaluation of need to determine the model required going forward with the value of the teams demonstrated.

 

24. The Cabinet Member for Children, Families and Lifelong Learning invited Members’ input into the business case for the application of further funding to be considered by the ICB noted in paragraph 39.

 

25. A Member questioned to what extent Social Prescribing had been adopted and in what respects could Social Prescribing prove constructive as part of early intervention measures. The CYP Head of Emotional, Mental Health & Wellbeing Commissioning summarised social prescribing in two Primary Care Networks in one area and the recruitment of a young person’s social prescriber and a family health coach. The evidence of the impact of these additions would be considered through a robust evaluation project.

 

26. The Chairman queried the caseload for counselling support for young people and the lack of continuity. The Executive Director for Children's Community Services, Surrey and Borders Partnership NHS Foundation Trust recognised the challenges around continuity which had resulted in an increase in workforce to meet needs and a project to improve handovers and induction processes was in place.

 

27. A Member asked how death by suicide would be reviewed. The Executive Director for Children, Families and Lifelong Learning explained that the safeguarding partnership had conducted a review of suicide in Surrey in response to what appeared to be a larger number of suicides than expected in the years up to 2020. All information regarding the review and recommendations implemented as a result, which included the drawing together of safeguarding and child death processes were available on the Safeguarding Partnership website. The Public Health Principal gave reassurances that the safeguarding and child death processes were embedded in Surrey.

 

28. A Member queried what was being done to ensure children and their families did not have to repeat their stories multiple times. The Programme Director, Mindworks confirmed that this was a key principle with shared decision-making being vital to the process. The current process was not streamlined and work continued towards children and their families not having to repeat their stories. The Director for Commissioning, Children, Families, and Lifelong Learning added that progress had been achieved by bringing children into services. The Programme Director, Mindworks, noted that the performance pack had not been included with the report papers and committed to make that available to the Committee. Action – The Programme Director, Mindworks

 

29. A Member asked if there was sufficient funding to deliver the neurodiversity pathway transformation pilot referenced in paragraph 80 in all schools. The Programme Director, Mindworks confirmed that the successful neurodiversity profiles pilot would be rolled out across all schools.

 

30. A Member queried why a young people’s Safe Haven was being piloted in Guildford following the closure of one in Redhill. The CYP Head of Emotional, Mental Health & Wellbeing Commissioning summarised the reduction in Safe Havens because of the pandemic and the current expectation that attendance would be low at approximately 40 per cent. Tough decisions were required to meet the needs of young people and an evaluation would be completed by April 2023 to inform how best to take Havens forward. The Member noted that location and public transport was key to maximising attendance.

 

31. A Member asked if it were anticipated that demand would reduce and how would that link to the budget. The Chief Executive, Surrey and Borders Partnership NHS Foundation Trust said that whilst future demand was unknown, the model could be changed to work in a care integrated way.

 

32. The Cabinet Member for Children, Families and Lifelong Learning asked if the Chairman would be minded to liaise with the Chair of the Children’s, Families, Lifelong Learning Culture Select Committee (CFLLC) to jointly write to the relevant chairs of the ICB regarding funding. The Chairman agreed that this would be a positive and helpful exercise.

 

33. The Executive Director for Children, Families and Lifelong Learning highlighted the lack of parity between physical and mental health.

 

34. A Member queried the support available for children impacted by disadvantaged backgrounds and experiences and asked to what extent were resources available to help with this work. The Executive Director for Children's Community Services, Surrey and Borders Partnership NHS Foundation Trust summarised a focus on providing comprehensive support to the most vulnerable children and families which included a deep dive on services and effectiveness. MindWorks were putting to use every form of corporate resource to consider productivity and efficiency. The Chairman suggested it would be beneficial for Mindworks to contribute to the health and inequalities task group.

 

35. A Member asked were there any challenges expected with the transition towards making more use of technology in the delivery of children’s emotional well-being and mental health services. The Executive Director for Children's Community Services, Surrey and Borders Partnership NHS Foundation Trust explained that there were challenges in aligning and integrating the technology of multiple partners in service delivery and added that work was underway with the Academic Health Science Network to identify apps that could balance the personal support currently on offer, however financial challenges could be expected around this. 

 

Recommendations

1. To establish explicit criteria and SMART performance metrics for measuring the outcomes and effectiveness of Children and Young Person’s Emotional Wellbeing & Mental Health services in relation to total requirements for mental health support in Surrey; and to report performance against these metrics to the Adults and Health Select Committee and the Children, Families, Lifelong Learning and Culture Select Committee every three months from June 2023.
2. To collate and share data on priorities, areas of need, waiting times for assessment and treatment, and outcomes for treatments as part of Children and Young Person’s Emotional Wellbeing & Mental Health services.
3. To ensure that there is accuracy and synergy of patient records, and that all organisations involved in treating patients can access and update these records accordingly.
4. For waiting times to be reduced across all pathways as part of all Prevention and Early Intervention measures, as well as through the process of Transitions.
5. To continue to advance social prescribing County-Wide, and to ensure that there are appropriate initiatives, workable processes, adequate funding, and sufficient resources for this.
6. To conduct a thorough review into training provision for Children and Young Person’s Emotional Wellbeing & Mental Health services frontline and managerial staff.
7. For early diagnosis and appropriate mental health support for Children and Young Persons with Learning Disabilities and Autism.
8. To monitor the impacts of waiting times for assessments and treatments on the acuity of Children and Young Person’s mental health conditions, including the impact of the proposed reductions in treatment sessions aimed at reducing waiting times.
9. To review strategies across agencies for prevention and intervention surrounding bullying of Children.
10. To bring this item back to a formal Adults and Health Select Committee meeting with an update on all the above recommendations (with representatives from the Children’s Select Committee present).

 

Actions/ requests for further information:

1. To write to ICB Chairs with requests for further funding to be allocated for Mental Health.
2. For a meeting to be organised between relevant Cabinet Members, the Executive Director for Children, Families and Lifelong Learning, and the Chair and Vice-Chairs of the Adults and Health Select Committee to formulate a plan to help implement Action 1.
3. The User Voice and Participation team to research and update the Adults and Health Select Committee and the Children, Families, Lifelong Learning and Culture Select Committee on the difficulties experienced by young people with autism and mental health issues combined.
4. The User Voice and Participation team to share their Action Cards with stakeholders relevant to the issues highlighted within these.
5. The Programme Director-Mindworks, to provide the Adults and Health Select committee and Children, Families, Lifelong Learning and Culture Select Committee with the Mindworks monthly performance packs.

6.    The Chief Executive, Surrey and Borders Partnership NHS Foundation Trust, to provide the Adults and Health Select committee and the Children, Families, Lifelong Learning and Culture Select Committee with an integrated and data-informed outcome measure by April 2023.