Idea Transcript
Wandsworth Transformation Plan for Children and Young People’s Mental Health and Wellbeing October 2017 Refresh 2015 - 2020
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Table of Contents Executive Summary........................................................................................................................... 3 1.
Introduction ................................................................................................................................. 4
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Definition and Scope ................................................................................................................. 4
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National Context ......................................................................................................................... 5
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London Context .......................................................................................................................... 6
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South West London Context ................................................................................................... 6
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The Wandsworth Context ...................................................................................................... 19
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Case for Change ....................................................................................................................... 30
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Engagement with Young People, Parents and Carers ................................................... 40
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Wandsworth’s Response to Future in Mind (2015) ......................................................... 43
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Governance and Accountability ....................................................................................... 73
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Wandsworth CAMHS Transformation Action Plan ..................................................... 76
12. Wandsworth Risk Register and Mitigations ..................................................................... 86 Annex 1: Transformation Board: Terms of Reference for South West London and St George’s Mental Health Trust (SWLStG) ................................................................................... 87 Annex 2: Terms of Reference for South West London Mental Health Network Group . 87 Annex 3: National CAMHS Transition CQUINs Milestones ................................................... 87 Annex 4: South West London Self-Assessment against the Healthy London Partnership Mental Health Crisis Guidance .............................................................................. 87 Annex 5a: CAMHS Early Intervention Psychosis Service Stocktake ................................. 87 Annex 5b: Early Intervention Psychosis CAMHS Audit ......................................................... 87 Annex 6: Waiting times Tracker for the Neurodevelopmental Service .............................. 87 Annex 7: Other Youth Offending Project Specific Outcomes Measures .......................... 88 Supporting Documents .................................................................................................................. 88 Annex 8: Youth Offending Annual Report 2016 - 2017 .......................................................... 88 References ......................................................................................................................................... 88
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Executive Summary Having successfully mobilised our resources in 2016/17, the Wandsworth Children Adolescent Mental Health Service (CAMHS) Local Transformation Refresh Plan 2017 sets out the next step in the journey to further embed programmes of work related to service re-design, filling gaps in provision (particularly in tier 2), embedding our new services, improving the effectiveness of our new services, scaling up and mainstreaming our new services. The refreshed plan provides an update on progress made against ambitions and priorities in the first transformation plan which was published in October 2015. The achievements are detailed in Section 6 of this plan. Table 17 provides a breakdown of investment in initiatives that have been commissioned in response to the national Future in Mind policy. This demonstrated that our partnership have acted swiftly to set up a broad programme of new provision, utilising the LTP funding to its full and ‘bending spend’ from other services to enhance our offer to young people, following guidance and evidence of ‘good practice’. Table 18 provides an overview of performance and outcomes of the Future in Mind transformation programme. This demonstrated that we are working at scale to improve emotional wellbeing and to transform our spectrum of services. Points 9.1 to 9.6 outlines detailed delivery plan for the Future in Mind transformation projects, which clearly sets out our rationale in addressing each of the five key thematic areas of delivery. We recognise that this transformation needs to be achieved in a whole system approach ensuring mental health is a responsibility for all. Wandsworth has continued to build on its model of delivery locally and has worked in partnership with other South West London Clinical Commissioning Groups (CCGs) to ensure that the ambitions of Future in Mind are achieved. Over the last twelve months our key priority development across South West London has been the development of a Specialist Eating Disorder Service, which is now operational and improving delivery and we have plans to improve this further. Collaboration has also focused on maximising resources, reducing duplication and developing a consistent approach to measuring and delivering quality and outcomes. We will ensure that the South West London work continues to be embedded in Wandsworth in a way that reflects the particular needs of our population and builds on the existing assets and strong partnerships which are already well developed in our local community. We have developed effective joint working arrangement between the CCG and Local Authority and continue to work together with providers, parents, children and young people to co-produce our transformation plans. We are passionate about Children’s and Young People’s Mental Health being co-produced for them; by them. This has been one of the key achievements over the last year and one which we will continue to build upon and develop. The refreshed plan should be read with reference to the CAMHS Transformation Plan published in October 2015 to support the local delivery of the Department of Health Future in Mind policy. We have developed the refreshed plan in collaboration with local partners and providers in consultation with children and young people. The refreshed plan was initially signed off by Senior Officers from the CCG and Local Authority, including the Director of Commissioning (CCG), the Director of Children’s Services, Assistant Directors of Early Years and Early Help. It was provisionally signed off by the CCG Clinical Lead for CAMHS on 31st October 2017, ahead of final sign-off by the Wandsworth Health & Wellbeing Board in November 2017.
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Wandsworth CCG CAMHS Transformation Plan 2017-18
1. Introduction The Wandsworth Transformation Plan for Children and Young People responds to the Department of Health Future In Mind policy and builds upon the local strategic objectives outlined in the Wandsworth Child and Adolescent Mental Health Service (CAMHS) Strategy, the Wandsworth Annual Public Health Report “Happy and Thriving Communities”, and the Wandsworth Joint Health and Wellbeing Strategy. The Department of Health Future in Mind policy highlights key themes that bring together core principles and requirements which we consider to be fundamental to creating a system that properly supports the emotional wellbeing and mental health of children and young people. In summary, the themes are:
Promoting resilience, prevention and early intervention Improving access to effective support – a system without tiers Care for the most vulnerable Accountability and transparency Developing the workforce Commissioning
This Transformation Plan sets a framework for the CAMHS Commissioning Partnership to meet the mental and emotional health needs of children and young people in Wandsworth. A number of key local drivers have been linked together with Future in Mind objectives and embedded within this plan. The October 2017 refresh is an update on current progress, investment priorities and a statement on our vision to 2020 as reflected in the South West London Sustainability and Transformation Plan. It reflect new areas of focus, for example our new work with young people involved in and on the edge of the youth justice system. 2. Definition and Scope Mental health is defined as “A state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”i Emotional wellbeing is defined as “A positive state of mind and body, feeling safe and able to cope, with a sense of connection with people, communities and the wider environment.”ii This Transformation Plan covers care for children aged 0 to 18 years, for whom Wandsworth is responsible either through GP registration or resident population, in need of mental health services for children and young people. Children with additional/ special needs would be managed based on the relevant legal framework and requirements relating to their ages
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3. National Context 3.1.
Department of Health Future in Mind (2015)
In March 2015 a parliamentary taskforce published its findings and recommendations following a review Child and Adolescent Mental Health Services (CAMHS). The key themes that emerged from the review are:
Promoting resilience, prevention and early intervention Improving access to effective support - a system without tiers Care for the most vulnerable Accountability and transparency Developing the workforce
The report highlighted that delivering the national ambition will require local leadership and ownership. It proposed the development and agreement of Transformation Plans for Children and Young People’s Mental Health and Wellbeing which will clearly articulate the local offer. The Plans should cover the whole spectrum of services for children and young people’s mental health and wellbeing from health promotion and prevention work, to support and interventions for children and young people who have existing or emerging mental health problems, as well as transitions between services. 3.2. Five Year Forward View for Mental Health Implementation Plan (2016) In July 2016, NHS England published an Implementation Plan to set out the actions required to deliver the Five Year Forward View for Mental Health. Whilst the Five Year Forward View for Mental Health is a single programme, it contains different and related elements across the health system for all ages. A core strand within this programme are children and young people. The key features of the implementation plan are:
Greater collaborative commissioning between the NHS and partner organisations Improved access to 24/7 crisis resolution and liaison mental health services that prevent the need for inpatient beds and inappropriate out of borough placements All areas having eating disorder services for children and young people in place that ensure 95% of children in need receive treatment within one week for urgent cases, and four weeks for routine cases. Increasing the capacity and skill set of the local workforce.
Other relevant national documents supporting the development of the local transformation plan for CAMHS are as follows:
No Health without Mental Health: A cross-government strategy Children and Young People’s Improving Access to Psychological Therapies (IAPT) 2010 Marmot review 2013-16 Public Health Outcome Framework Better health outcomes for children and young people: Our pledge Report of the children and young people’s health outcomes forum.vi Healthy Child Programme documents – the first five years of life and from 5 to 19 years House of Commons report on Children’s and adolescents’ mental health and CAMHS NHS Five Year Forward View
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4. London Context 4.1. Healthy London Partnership Children and Young People’s Programme The Healthy London Partnership Children and Young People’s Programme brings together the NHS in London (Clinical Commissioning Groups and NHS England), the Mayor of London, Greater London Authority, Public Health England, London Councils and Health Education England to achieve better health and care for all Londoners. In 2017/18, London CCGs have identified the following priority themes for the Healthy London Children and Young People’s Mental Health Programme:
Crisis care - support commissioners/providers to implement the Healthy London Partnership Children and Young People Mental Health Crisis Care guidance. Data and information Learning Disability Eating Disorders Directory of Services ( MiDoS) Thrive London and Digital Mental Health programme Workforce
5. South West London Context 5.1.
South West London Sustainability Transformation Plan
The vision for the South West London Sustainability and Transformation Plan (STP) is for people live longer, healthier lives. They are supported to look after themselves and those they care for. They have access to high quality, joined up health and care services when they need them that deliver better health outcomes at a lower cost of provision to the system. The South West London Sustainability Transformation Plan (SWL STP) is the key vehicle for transforming Child and Adolescent Mental Health (CAMHS) services in SWL and achieving the targets set out in the Five Year Forward view. SWL CCGs have identified the following priorities aligned to the SWL STP. Wandsworth CCG is working at STP level with Specialised Commissioning and Wandsworth CCG Service Users to develop and implement transformation plans. These priorities are also outlined in the SWL CAMHS collaborative plan, which South West London have developed as part of our work to implement the Five Year Forward View for Mental Health (DOH 2016). 5.2.
South West London Sustainability Transformation Plan and Local CAMHS Transformation Plan Priorities
South West London Sustainability and Transformation Plan align with the Children and Young People’s Mental Health in the following ways:
The South West London STP will promote commissioning of consistent out of hours services for young people to manage crisis and prevent escalation with the ambition of managing demand effectively in the community and reducing inpatient admissions.
Oversee consistent delivery of multi-agency pre-admission Care and Treatment Reviews for children and young people with LD, and/or autism to reduce inpatient admissions.
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Work with NHS England Specialised Commissioning Team, CCGs and Local Authorities commissioners to design and commission effective community pathways with robust links to local acute inpatient services with ambition to reduce lengths of stay and inappropriate placements.
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Access to appropriate beds locally to prevent people having to travel long distances to receive care, which can disconnect them from their family and local community
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Implement changes to the SWL Eating Disorder Service to ensure it meets the new Access Waiting Time Standards
Implement 24/7 Crisis Care model in line with Healthy London Partnership Crisis care standards Increase proportion of children with a diagnosable mental illness receiving evidence based treatment to 35%
Contribute to the national target for an additional 1,700 clinicians, and to train and upskill 3,400 of the existing staff complement in CYP IAPT, by 2021.
Work with NHS England Specialised Commissioning Team to continue to:
ensure Regional inpatient capacity to ensure out of region admissions become the exception to reduce variation by introducing standardised access and waiting times adopt consistent models of care based on best practice that reduce the reliance on inpatient care deliver seamless age-related service transitions to support the pilots within the New Care Models programme (NWL)
To meet the workforce requirements (refer to 5.13), SWL Commissioners are working with STP Workforce Leads on the SWL Workforce Development Plan. This joint work will deliver and implement a workforce plan for SWL’s contribution to increased workforce capacity, capability and sustainability within CAMHS. Governance and assurance for Local Transformation Plan alignment to the STP is provided by the SWL Mental Health Network (refer to 5.3.2). The Local Transformation Plans will be led and signed off by individual CCGs, but the SWL Mental Health Network will work with commissioners to understand common themes, share learning and ensure alignment to the STP. 5.3.
Collaborative and Place Based Commissioning
A Collaborative Plan has been agreed between SWL CCGs, SWLStG and Specialised Commissioning. The Collaborative Plan identifies the following priorities and work is being undertaken at an STP level to determine how these will be implemented and delivered: Access to appropriate beds locally thus not having to travel long distances, face long waiting times, or disconnect from family and their local community Availability of services out of hours Develop more quality measures by service units Support for young people when they return home after specialised CAMHS admission Children’s services to map neatly onto adult services affecting transition Consistent commissioning arrangements between community and specialised CAMHS Consistency in care and discharge plans
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More multi-agency support to help children and young people with mental health problems to stay in community and prevent hospital admission Depict accurate picture of specialised care as not a “solve all” Better utilise funding available for services Delivery of the Collaborative Plan is underpinned by an action plan that sets out the key actions, milestones , timescales and outcomes that will be required to be delivered in order to achieve the collaborative place based commissioning agenda. There is a local governance framework in place to ensure leadership, implementation and progress monitoring of the Collaborative Commissioning Plan. The governance consists of the following: 5.3.1. The Transformation Board The Transformation Board as a super task and finish group and remains within overall SWLStG contract governance. The Transformation Board is supported by Task and Finish Groups who are required to recommend and drive agendas; programme plans; action plans and actions appropriate to the subject area. Key areas of focus for the Transformation Board are as follows:
Perinatal : CAMHS/CYP Community Urgent Care CIP/QIPP Tariff Development
The full governance map including terms of references and membership for both groups is enclosed in Annex 1. 5.3.2. Mental Health Network The Mental Health Network is responsible for developing the Mental Health Vision and Strategy for South West London and for supporting the delivery of the Five Year Forward View for Mental Health. In its pursuit of this objective the Mental Health Network will provide Oversight; Facilitation and Sharing at an STP level in relation to Mental Health Transformation. The SWL Mental Health Network is chaired by the SRO for mental health in SWL and provides strategic oversight of the transformation of mental health services and delivery of the Five Year Forward View for mental health in South West London. Moving forwards, the Mental Health Network will review what has successfully delivered and monitor benefits and outcomes, against the key performance indicators. The Network will also identify the issues that are potentially impeding progress to enable escalation and action. See Annex 2 for Terms of Reference 5.4.
South West London Sustainability and Transformation Plan CAMHS Key Performance Indicators.
The SWL STP CAMHS Key Performance Indicators are as follows:
Elimination of inappropriate placements to inpatient beds by 2020/21 (measured by total bed days in CAMHS tier 4 per CYP population / total CYP in adult in-patient wards/paediatric wards
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At least 35% of CYP with a diagnosable MH condition receive treatment from an NHS funded community MH service by 2020/21; additional CYP treated over 14/15 baseline.
95% receive treatment for eating disorders within 1 week for urgent cases / four weeks for routine cases and significant reduction in use of specialist inpatient beds for CYP with an eating disorders by 2020/21.
24/7 Crisis Care model of care is in place in line with Healthy London Partnership Crisis care standards.
The SWL target and contribution to national target of additional 1,700 CAMHS clinicians and 3,400 IAPT trained and Upskilled staff agreed with Health Education England and SWL STP Workforce Leads. 5.5.
National CAMHS Transition Commissioning for Quality and Innovation
The National CAMHS Transition Commissioning for Quality and Innovation (CQUIN) is intended to improve the outcomes for young people who transition out of CYPMHS; to improve young people’s experience of transition; to improve young people, parent and carer involvement; and to incentivise the safe transfer of care for young people. The point of transition from Child and Adolescent Mental Health Services is recognised as a point of potential upheaval for young people who may find it difficult to navigate new service settings, or to manage their mental health following discharge from CYPMHS, especially as the availability and offer of support can change dramatically from CYPMHS to AMHS or voluntary sector services. It is estimated that more than 25,000 young people transition each year. It is reported that this process is often handled poorly, which can result in repeat assessments and emergency admissions for this large cohort of service users at a critical stage in life. Recent research has highlighted how few people make the transition across to adult services, which have a different culture to CYPMHS services and focus more on clear diagnostic categories with the result that AMHS often exclude young people at the point of transition who may go on to develop more severe problems. Moreover, even when adult services do accept a referral, there is no guarantee that the young person’s transfer will be handled properly, and they may go on to disengage from services all together. The TRACK study shows that transitions for young people at the age of 18 are poorly managed resulting in only 4% of young people receiving an ‘ideal transition’. Transitions for vulnerable groups, such as those within the criminal justice system can be particularly problematic. South West London Commissioners have requested the information in Table 1 below from South West London & St Georges Mental Health Trust which outlines the rate of transition by CCG across South West London and how long the transition to Adult Mental Health Services takes. A total of 269 service users transitioned out of CAMHS at 18+ years old. Of these, 62 transitioned into adult services within +/- 2 months of their discharge from CAMHS The transition data is inclusive and incorporates those children with Autistic Spectrum Disorders / Severe and challenging behaviour that Transition to Adult Services.
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Table 1 – Breakdown of Service Users 18+ who transitioned out of CAMHS CCG Local
Clients
NHS KINGSTON CCG NHS MERTON CCG NHS RICHMOND CCG NHS SUTTON CCG NHS WANDSWORTH CCG Other
60 27 70 49 57 6
Total Above clients with adult (RiO or IAPT) referral within (31 and 61) days before or after CAMHS discharge
269
CCG Local Days NHS KINGSTON CCG NHS MERTON CCG NHS RICHMOND CCG NHS SUTTON CCG