Minutes:
MEMBERS QUESTIONS IN RELATION TO AGENDA ITEM 7 (SEND PRESENTATION AND Q&A SESSION) – RESPONSES PROVIDED AFTER THE PANEL MEETING
Q Could you provide the following:-
A) details of the services that you are providing
In April 2020, Specialist Children’s Community Services transferred from Weston Area Health Trust and North Somerset Community Partnership to Sirona Care & Health and Avon & Wiltshire Mental Health Partnerships.
This included:
Sirona care & health
· Community Paediatrics
· Therapies (Speech and Language, Occupational Therapy, Physiotherapy)
· Continence Services
· Autism Pathway
· Safeguarding
· Children in care
· Neurodevelopmental services
· Lifetime
· School Nursing (due to be recommissioned by North Somerset Council)
· Health Visitors (due to be recommissioned by North Somerset Council)
AWP
· Children & Adolescent Mental Health Services (CAMHS)
· Urgent Care Assessment Team (UCAT)
· Kooth
· Off the Record (commissioned post service transfer and is currently being implemented with expected delivery from July 2021).
· Crisis Helpline – implemented during COVID-19. Helpline that can be accessed by children and young people, parents and carers, and professionals 24/7.
· 24/7 Crisis Service (commissioned post service transfer and is currently being implemented across BNSSG during 2021)
It is important to note that there were known issues relating to the CAMHS services prior to the service transfer with an inadequate rating from CQC in place. There were a number of Must Do’s from CQC that the service was required to undertake. Once it transferred to AWP in April 2020, AWP embarked on a project to ensure that an action plan was in place to address the issues identified by CQC and to make the service ‘safe’. This included:
· Risk and Incident training and processes
· Implement processes to ensure that children on the waiting list are prioritised based on need and contacted whilst they are waiting
· High risk - booked in for an immediate assessment
· Medium risk are placed on the waiting list with contact every 4 weeks to review the situations and risk.
· Low risk are placed on a waiting list and are contacted every 12-weeks
· Implementation of an electronic record system, transferring paper records and data validation
· Significant workforce issues remain and AWP have implemented a recruitment plan to incentivise people to work in North Somerset
Sirona, AWP and the CCG have met with North Somerset Parent Carers Working Together, twice during 2020/21. At the recent meeting, Sirona & AWP outlined the additional work that has been undertaken since the transfer of services and as a result of parent carer feedback. This included:
· Piloting drop in clinics for parents, carers and professionals with North Somerset Therapies service
· Setting up advice and guidance lines
· Commissioning Off the Record to provide sub CAMHS provision for children and young people
· Identifying service gaps in North Somerset
B) What the measures of success are and performance against these measures
There are a number of local and national measures that the service must report against. This includes access to services, referrals data, and children and the time children and young people are waiting for services. The provider works towards the following KPIs (though to be aware, due to current pressures within services these are extremely challenging to meet)
· Emergency referrals within 24 hours
· Urgent referrals assessed within 1 week
· Routine referrals assessed within 4 weeks
· New people receiving treatment (At least 2 sessions)
There are challenges within the North Somerset services such as long waits to be seen which was inherited at transfer. This is partially due to the high numbers of referrals received coupled with thecapacity of the service to undertake assessments. As noted above, AWP are working to recruit into vacancies and to build the resilience of the services as well as develop a pre CAMHS service (Off the Record). These capacity issues are having a significant impact on AWPs ability to achieve national and local measures.
Additionally, it is known that there is a gap in service provision in North Somerset which is currently being identified by Sirona and AWP and being discussed with the CCG. A plan will be developed to address the historical gaps in service to ensure that North Somerset services are developed and aligned to the offer in Bristol and South Gloucestershire.
As mentioned, AWP have now implemented an electronic record system for North Somerset CAMHS and undertaken a process of data validation. Now this process has been completed, the provider has developed a performance dashboard which will be shared with commissioners later this month.
C) If, for example, you are unable to meet a measure, eg waiting list for a
CAHMS referral, what recourse is there?
The CCG has regular contract meetings with Sirona and AWP where performance issues and concerns are raised. Where there are significant concerns, the provider will identify mitigating actions that need to be put in place.
The CCG has a wider meeting with associate commissioners which now includes North Somerset Council and providers called ‘Integrated Care Quality and Performance Meeting’. Any concerns that require escalation can be discussed at this meeting with partners to understand the problem in more detail and the plans to address.
Additionally, there are contract levers available to Commissioners called Contract Performance Notices. These can be used by Commissioners where performance continually drops below standards and this will trigger a joint meeting and action plan to be developed.
The CCG works closely with providers to develop actions to address issues which can negate the need to use CPNs and enables a more system approach to problems to take place.
Q I am going to go about this from a perspective more as a long term low level service user. When HOSP started building relationships with AWP about a year ago community services seemed to be a much lower level. A lot of people are very cautious about the digital approach, but as a service I found it really hard trying to access mental health resilience networks and seeing all these online materials available for other Local Authorities but not ourselves. I really Off The Record coming here particularly. They are very innovative and really good at improving reach. Just wanted to note how positive the direction of change seems to be.
Q We’re talking about ‘what you are doing to respond now’ on websites I can see countless jobs hiring online, we’ve talked about things taking a year – if they’re recruiting in April will these service providers not come quickly?
The only other thing I was going to add is that I was a wellbeing chair of my university college when it had a suicide epidemic, we were able to transform things in York but a real learning point is that we need to be really careful about how we talk about youth suicides in public meetings in the future.
Off the Record has been commissioned to expand into North Somerset. The service has started to engage with local organisations and children and young people to help to tailor the offer to the North Somerset Population.
OTR have gone out to recruit with interviews now taking place with an expectation that individuals will start in post during May.
The next steps will be to meet with existing organisations such as CAMHS, YMCA, School Nurses, 65 High St to build up a network of services in the area in order to understand the offer in North Somerset and how existing services can complement and flex with OTR. OTR will build on engagement with Children and Young people to begin talking about and promoting services.
Currently, the service is exploring how it will phase the roll out of the services and to look at what can be put in place to support with demand. It is expected that the phased implementation will start in June / July with some interventions beginning at this time. There is also a plan to deliver specific training to schools and other therapeutic groups during this time.
Q How is it possible for councillors to scrutinise the performance of Kooth, the online app for mental health.
I just wanted to know which partner organisation commissioned this and how is the service scrutinised? If there are audits could the CYPS Panel see these?
The CCG contract with Sirona to provide the Children’s Community Health Partnership Contract which North Somerset services are now part of.
As part of this contract, Sirona contract with AWP to provide CAMHS services and AWP hold a sub-contract with Kooth.
Kooth is an online mental wellbeing community with access being free, safe and anonymous support. Young people have the ability to chat with live counsellors as well as being able to access self-help information.
Kooth operates to a Quality Framework and shares detailed performance data on a quarterly basis. This includes a number of outcome measures and goals for children and young people that Kooth are then monitored against.