Agenda item

The Associate Director of Children’s Services, Sirona Care and Health provided Members with a presentation on an Introduction to the Children’s Community Health Partnership (CCHP), a copy of which was filed in the minute book.

Members were informed that Sirona was the prime provider and directly accountable to the CCG and the three local authorities (Bristol, North Somerset and South Gloucestershire) on how children’s commissioning services were run. The services provided under the umbrella of Children’s Community Services were outlined to Members.

Members noted the complex landscape of how business was carried out in children’s services across BNSSG.  It provided an opportunity for Sirona to think BNSSG wide and create an equitable, responsible, responsive service for all children, families and communities.  Strategically Sirona was reviewing every service within the Children’s Directorate to ensure that it was responding to the needs of local services such as those in North Somerset.  The Associate Director of Children’s Services had created strategic leads that sat across the whole BNSSG framework to lead on the service reviews and to make sure that services were being delivered within the geographies that were consistent and equitable across all the areas served.

The Associate Director of Children’s Services outlined the staffing structure in Sirona with particular reference to the Head of Children's Services Therapies, Autism and SEND whose responsibilities included therapies (speech and language therapy, occupational therapy, physio therapy), early years practitioner service, autism hub service, associate designated clinical officer service, associate designated clinical officer service and children’s traded service.

Particular attention was drawn to the fact that it was crucial to ensure the SEND and EHC requirements were correct across the three local authority areas. It was the responsibility of the Head of Children’s Services for Therapies to ensure that Sirona had the commitment and interface between education, health and the local authority via the SEND partnership. 

Reference was also made to the Head of Specialist Services for Children whose responsibilities covered children in care, lifetime immunisations, neurodevelopmental services, continence services and transition. The specialist nursing team who were looking at transitions and some of the ‘cliff edges’ that needed to be addressed in supporting young people as they moved into adult services.

It was reported that a new Clinical Director had been appointed (supporting the Associate Director of Children’s Services in the community paediatrics framework, some of the ASD and education health care requirements and children in care). Responsibilities of the role were paediatrics (BNSSG), delivery of service, paediatricians, safeguarding.

The Associate Director of Children’s Services, Sirona (LM) and Head of Operations for CAMHS, AWS (HK) responded to the following queries from panel members (with responses in italics):-

·       With regards AWP who you subcontracted – it is very difficult as part of the CYPS to work out how we can scrutinise some of the performances of so many disparate partners.  One of the things I was looking at was ‘Kooth’ and ‘Off the Record’.  Who commissioned them and how are these scrutinised? ‘Kooth’ is an American funded app and I can’t see how we work out its effectiveness.  ‘Off the Record’ is more open because it is a charity based organisation in Bristol and we would be able to see the trustees.  How do we manage ‘Kooth’s’ performance? -  I will begin to describe the contractual responsibilities if that would be helpful.  Ultimately, myself, Sirona, is responsible for all of the prime and I am responsible in a contractual and commercial basis and for the whole service offer. Within the prime responsibility I share that responsibility in a sub-contracted way to AWP.  AWP subcontracts ‘Off the Record’ and ‘Kooth’.  Ultimately, I am responsible for everything that is delivered in Children’s Services.  However, there is a responsibility from a professional and commercial basis and that scrutiny goes in a matrix so that Sirona commissioners have a line of sight to all sub-contractors in order to test, understand, review and reflect around service offers. (LM)

·       Have you reviewed ‘Kooth’ and can you share with us what their performance has been? – I don’t have the data in terms of ‘Kooth’.  ‘Kooth’ is an online professionally qualified children’s counselling provision.  There are a number of performance measures – assuring that young people meet a number of goals and they set goals with young people.  We can measure the goals and check improvements against that.  Kooth also maintain a large library of resources and peer led resources that are available online which is moderated, not unlike ‘Off the Record’.  The entire platform is online and national.  Wherever they set up across the country (and I have worked with them in different parts of the country) they always have to have close links with the mental health providers and clear mechanisms for escalating any concerns about young people as well as safeguarding young people.  There are very detailed quarterly reports monitoring their performance as part of this contract. (HK)

·       I was going to ask where children’s mental health fitted into that structure LM but I think you have said you manage that relationship with AWP.  Given the pandemic that area is huge and has grown even more over the last 12 months -  As children return to school we will learn more and more about the challenges facing children over the next 12 months.  In relation to the children in need of crisis intervention there is something for them going forwards but it is the well kids that would have been ok that we need to make sure there are tools in place for them to face some of the challenges. (LM)

The Head of Operations for CAMHS, AWS Partnership NHS Trust (HK) outlined the key members of the team which included herself  as responsible for the day to day running of the service,  Clinical Director CAMHS, Clinical, Lead CAMHS,  Associate Director, CAMHS, Head of Operations – BNSSG CAMHS, North Somerset CAMHS Service Manager.

The services provided by CAMHS were as follows:-

•        Children’s and Adolescents Mental Health Services (CAMHS)

•        Eating Disorders

•        Substance Misuse (not within North Somerset)

•        Youth Offending Teams (within the LA in North Somerset)

•        Urgent Care Assessment Team

•        Provide a specialist in patient specialist CAMHS provision primarily for Bristol, North Somerset and South Gloucestershire  – closed at the moment for refurbishment but providing a day provision.  Will be re-opening with an increase in beds in June.

The Head of Operations for CAMHS, AWS, explained that one of the first actions that had been carried out very early in the contract moving to AWP was the introduction of an electronic patient record.  This had resulted in there being a very robust record and also enabled the monitoring and support of both the risks young people presented with and also the waiting list in North Somerset. 

The focus was on developing the workforce and new members of staff were now joining the team.  The team had been without a substantive psychiatrist for some time but the first one was starting in May and another advertisement had been published to attract some more applicants.

There had also been investment in crisis.  Previously there had been a very small team in North Somerset. After benefitting from some new investment a recruitment campaign had been undertaken to ensure that it would be available 24-7. This would have a significant effect in terms of improvement in the area.

‘Off the Record’ would be introduced which was similar to the offer to Bristol and South Gloucestershire – face to face counselling and wider resilience particularly focused pre specialist CAMHS.  Members were informed there was a strong working relationship with ‘Off the Record’.   

There was also a desire to incorporate mental health support in schools. It would not be possible for there to be a team in North Somerset this year as the goal had been to introduce Off the Record and get that support into North Somerset over the next year and introduce the mental health team the following February.  There would be pre-CAMHS support and the recruitment process was currently taking place.

Members raised the following questions/queries (with responses in italics):

·       What does North Somerset want from you and what do you want from North Somerset as a partnership? – to think in terms of the offer and the parity of the offer in North Somerset compared to Bristol and South Gloucestershire is an ambition.  At the moment the offer is quite different.  There is something about how we come together within specialist CAMHS.  It is a very small resource.  We need to think about the model and framework of delivery and how we can strengthen some of those pathways.  Some of that has been covered in the strategy going forwards (HK).

·       I am concerned in relation to children’s mental health.  I can understand you are in a difficult situation but I want to see that we have people who can deal with it now.  A year down the line is not acceptable.  I would like to see something done and an urgency put on it.  It is not one fix fit all – you have to identify something and if it is not done it will have consequences.  What is going to be put into CAMHS now? – The service does still have quite a long waiting list.  We are working very hard to re-develop the pathways to make sure children are being seen quickly. There has been focused investment there and there is a much bigger piece of work to see what we do pre-specialist provision.  We are seeing a lot more children presenting. There needs to be focus on what we can do earlier with early intervention and prevention.  The mental health teams in schools will be part of it.  We may not have seen some of the children pre-Covid (increasing anxiety etc).  We are investing in our specialist practitioners who are trained in the evidence to treat anxiety.  We are over recruiting around supporting children with eating disorders as that is one of the areas we are seeing an increase in.  We are re-aligning services.  There is a lot of work to be done but we are really thinking about the pathway and working in partnership is the way forward.  At the moment I have some additional funding.  We have spoken to ‘Off the Record’ which will go live in April 2021.  We will be able to support a lot of people in terms of lower level resilience.  I have a whole re-design project in terms of what that community should look like across the areas. (HK)

Mental health is everyone’s business and we are trying to raise that profile with parents and schools so that they have some of the tools to deal with that.  It is also crucial that we have specialists to deal with high levels of need. (LM)

·       Comparing North Somerset to South Gloucestershire and Bristol can you clarify how much per unit we receive? How do we also compare with waiting times? – I don’t have the splits to hand and we are working with North Somerset and AWP to identify what the funding is in both the areas.  They are contracted and commissioned differently and have now moved across to AWP. CAMHS need to look at the funding available to all services and ensure equity across the 3 areas.  This includes working with the local authority and public health as in Bristol and South Gloucestershire. I am happy to find out and feedback to you with those figures.  (AN)

We recognise there is a gap in the service offer in North Somerset from a health perspective. As Sirona, the provider, I have got to make sure as a result of North Somerset being part of my portfolio it does not dilute the offer to Bristol and South Gloucestershire and we work with North Somerset in respect of the levelling opportunity that needs to happen.  We are really trying to work with what is an offer for Bristol and South Gloucestershire (mental health and therapies perspective) and how does that compare with North Somerset and how do we get that up rather than dilute the offer. (LM)

We want to look at levelling up the services.  We have contributed additional funding to the CAMHS services in North Somerset on a recurrent basis, for example funding for ‘Off the Record and the other end re crisis services – moving North Somerset from a 9-5 offer to 24/7. (AN)

The waiting list is longer in North Somerset.  The key success of some of the waiting list work in Bristol and South Gloucestershire (and we are now bringing that learning into North Somerset) is that it is not just about us bringing in additional resources, although that is part of it.  It is also about the re-design of the service so that young people are supported in the right pathway (and don’t have to go through so many hoops to get the specialist provision) and access it earlier on in the process, where appropriate.  We are already doing that in terms of how we are changing some of the systems and processes.  There is a benefit for North Somerset as it is joining a much larger service.  Some of the transformation will be different in North Somerset but there is a lot of learning that we are already doing in North Somerset. (HK)

·       I am not getting the impression that North Somerset is getting access to CAMHS services for this year and instead we are getting ‘Off the Record’ but they are not yet appointed.  I am concerned there is going to be a gap. We, as a local authority, have a statutory duty to provide adequate services.  It is absolutely at a crisis point because it is impacting specifically SEND pupils in particular.  There is a huge need.  I do not accept that North Somerset can be left out and told to wait.  We need details about levelling up and we need to do it now.  The amount of need is extraordinary.  I appreciate that CAMHS is spread out and you are dealing with other areas, other than just North Somerset but can we please have some feedback and honesty on this.  There aren’t appointments yet at ‘Off the Record’ and I am afraid children will fall through the gap.  Can you tell us when CAMHS will be covering North Somerset? – CAMHS services are available in North Somerset already.  They require some pathway development and changes to bring them in line with Bristol and South Gloucestershire now that AWP are providing them, but CAMHS services are absolutely available to our North Somerset population (AN).

We are seeing young people in North Somerset.  We are doing a significant piece of work to reduce the wait times.  We have put in additional practitioners now in terms of crisis.  I have already doubled that offer since April in terms of the staff who I have providing that support.  We have a very large recruitment campaign and we have had some very successful appointments joining the existing CAMHS team. It is not a quick piece of work.  I agree that with the pandemic we are talking of what additional resources can come on side to support traditional services too. (HK)

·       In respect of the services you offer – what, if any, specialist teams and advice have you got for young people struggling in terms of anxiety over sexuality, sexual orientation and gender identity?  I feel the pandemic has magnified these concerns for many young people.  I receive communications from families that they are not getting the support and finding it hard to find – We have a pathway for young people that we support within CAMHS and we also have support from some of our national colleagues from London who work alongside us to support us.  We will also refer to some of the specialist pathways who provide support and some charities as well. We could certainly look at the pathway and I know ‘Off the Record’ also provide support alongside our services (HK).

It is important to create health awareness of those issues so that we signpost people to the services and there is no wrong door.  We make sure our health visitors understand it and encourage parents to talk about it and teachers and therapists.  Where there is a child who has need and it gets to a level of need to create that specialist pathway it is there. (LM)

·       Could we work more closely with the LGBTQ in this area? – we are in the process of developing our new website as well and absolutely that is a critical part of our service provision (HK).

·       I have seen countless times children waiting for CAMHS appointments.  It is not a new phenomenon.  What makes the service new now that you are offering? You are realigning resources, when you mention pre-CAMHS, is this the triage system? With the CAMHS situation and the number of children needing urgent attention we are not hitting the goals.  Why have we not managed it before and how are we going to manage it now? -  It is difficult to talk about the historical issues in North Somerset.  It is well recognised that children’s mental health is a key priority.  There is a need for increased investment in children’s mental health both in a specialist pathway but also early intervention. Apologies if I have said we have got it right.  We are making improvements.   Within North Somerset there is a need to think about children’s early emotional wellbeing support, mental health support pre-specialist and having some of those services available. ‘Off the Record’ will be the starting point for that.  There is more that can be done and more investment in schools of which the mental health teams will be a part of particularly around young people presenting with anxiety and behavioural problems.  What we need in terms of the specialist provision is to make sure children are seen as quickly as possible.  We have changed the triage system. Young people are reviewed every day.  Young children who are on the waiting list are telephoned.  We have a robust RAG rating for risk.  We have increased the crisis provision for the North Somerset team.  The pathway redesign is really important.  It is about ensuring that children have the right support.  Triage is critical in terms of understanding the issues that children are presenting, having a really comprehensive assessment of that young person and getting the right pathway.  We are emphasising that support around high risk at the moment but that needs to be across all of our pathways (HK).

A discussion took place on the parity of funding.  It was agreed to set up an investigative working group to look at the parity of funding and access issues to service – pathway and service re-design.

The Chairman thanked the NHS representatives for attending the Panel meeting and for the presentation.

Concluded:

(1) that the Panel convene a Joint CAMHS (CYPS & HOSP) Working Group (to include Cllrs Wendy Griggs, Huw James, Caroline Cherry, Steve Hogg, Sandra Hearne, Kenton Mee and NHS representatives -  Anna Norris, Heather Kapeluch, and Lorraine McMullen).

(2) that panel members submit any further questions via meeting chat or to the Democratic and Electoral Services Officer to be answered by the health representatives after the meeting and attached as an appendix to the minutes.