Transforming Child & Adolescent Mental Health Services (CAMHS) Update to Health & Wellbeing Board October 2019 1
North West London Local Transformation Plan 2015-2020 Following the publication of Future in Mind in 2015 and the funding associated with it, from August 2015, all 8 CCGs across NW London have had a joint CAMHS Local Transformation Plan which outlines how investment will improve CAMHS. This is coordinated by the LikeMinded Team in North West London . This has ensured a lean approach to implementation and enable consistent standards to be driven up across the 8 boroughs, however the plan also reflects local differences and priorities in individual borough annexes. This plan has been refreshed every year since 2015, and is now in its final iteration. 2
What did CAMHS look like in 2015? • High investment high up the triangle and lower investment lower down • Following a number of key stakeholder workshops, a number of priority areas were highlighted : – Early Help & improving access – Vulnerable Groups – Eating Disorders – Crisis Care • Lower overall investment Escalating level of need Tier 4 Increasing spend Tier 4 Spend Tier 3 Tier 3 Spend Tier 2 Tier 2 Spend 3
What does Hounslow CAMHS look like in 2019? Provided by: Based: Tier 4 Various private providers e.g. The Inpatient Priory Out of borough Tier 3 Budget: £2.4m p/a Heart of Hounslow Workforce: 39 WTE Level of need Tier 2 (including CWP & MHST) Budget: £913,000 2019/2020, £1.3m In the community & at The 2020/2021 Meadows Health Centre Workforce: 15.18 WTE Tier 2, 17.6 WTE MHST, Single Point of Access Early Years 57 Primary 16 Secondary 5 Special 1 FE College & 1 PRU Settings Schools Schools Schools 2 Studio Schools Voluntary & Health Visiting & Social Primary Leisure & Care Care Community Services School Nursing Youth Services Tier 1 4
CAMHS Transformation Funding CAMHS Local Transformation Proportion CAMHS Spend on Funding 2015-2020 priority areas £700,000.00 £600,000.00 £500,000.00 £400,000.00 £300,000.00 £200,000.00 £100,000.00 £- 15/16 16/17 17/18 18/19 19/20 CAMHS Local Transformation Plan Funding Eating Disorders Funding (included in WLT block contract) Eating Disorders Vulnerable Groups Early Intervention Crisis Care 5
Eating Disorders CAMHS Transformation Investment: £152,983 per year The Community Eating Disorder Service for children & young people was established in April 2016 ; provided by West London NHS Trust; based in Ealing. • Service for young people <18 who have a suspected or confirmed diagnosis of anorexia nervosa, bulimia nervosa, binge eating disorder, atypical anorexic and bulimic eating disorder. • Delivers NICE concordant treatment and care via a multidisciplinary team, including Family Therapy, CBT and Dietetics. In 2018/19, 16 young people from Hounslow accessed the service and 100% were seen within the prescribed waiting time : 1 week for urgent assessments and 4 weeks for routine assessments. 6 6
Early Help & Access CAMHS Transformation Investment: £142,056 per year NHS England funding for MHSTs: £770,000 19/20, £1.2m 20/21 A number of service developments have been implemented to improve early intervention and access to specialist CAMHS for those who need it: • Single Point of Access to CAMHS established in 2016 to simplify access for families and referrers • Investment in voluntary and community sector providers including MIND, Homestart and Hounslow Youth Counselling Service, enabling access to support for c. 150 children per year who may not meet the threshold for CAMHS. • Development of new posts in CAMHS , Child Wellbeing Practitioners , to provide evidence-based interventions for mild to moderate mental health needs, increasing access to c. 100 young people per year and reducing Tier 2 CAMHS waiting times. • Redesign of model of care in Tier 2 CAMHS , reducing the waiting time from 52 weeks to 5 weeks (now stabilising at under 12 weeks). For Tier 3 CAMHS, 79% of children are seen within 18 weeks (18/19 data). • Selected as a national Trailblazer site to establish Mental Health Support Teams in schools. £1.2 m new funding from NHS; 3 teams East, Central and West based in hub schools; providing early help. • Exceeding the national access target to reach 34% of the estimated need in the population. 7 7
Crisis Care CAMHS Transformation Investment: £142,056 per year Incremental changes have taken place since 2015 to develop a 24/7 crisis care pathway for young people: • Step 1: Providing Paediatric Liaison at West Mid, to ensure timely specialist assessments, support and onward transition for young people with mental health needs who have been admitted • Step 2: Establishing a CAMHS Out of Hours Service , providing specialist response for young people who present at West Mid A&E out of hours • Step 3: Working in partnership with NHS England on the New Models of Care (NMOC) project to take on responsibility for managing Tier 4 inpatient admissions at a local level, reducing length of stay and reinvesting savings in the community crisis pathway. • Step 4: Merging all of the above and introducing extra capacity for intensive support in the community during extended daytime hours to reduce the need for A&E attendance – the CAMHS Alliance Team. Key outcomes include: � Timely emergency response from a CAMHS specialist � Reduction in need for Tier 4 admissions and length of stay � Over time: reduced escalation of need to crisis point 8
Learning Disabilities & Neurodevelopmental Disorders CAMHS Transformation Investment: £54,028 BICS funding: £120,000 Neurodevelopmental pathway investment: £1m+ Focus on reducing the waiting time for assessment following doubling of demand between 2013 and 2018 to c. 800 referrals per year, and increase in waiting time to up to 2 years: • Some investment 2016-18 and review of assessment pathways to maximise efficiency • Significant new investment (£1m+) agreed in 2019 to clear static waiting list and achieve sustainable waiting time within 18 weeks from Dec 2020. Developed intensive Positive Behaviour support service for children with LD/ASD at risk of placement breakdown or hospital admission. • £120k per annum for Behavioural Intensive Community Service (BICS) • Successfully supported 16 young people to remain with their family and engage with education between 2017 and 2019 • Dynamic Risk Register in place for multi-disciplinary planning for ‘at risk’ young people 9
Vulnerable Groups CAMHS Transformation Investment: £178,000 per year CSA Hub funded by NHS England Targeted mental health support has been put in place for vulnerable groups who may be less likely to engage with traditional CAMHS: • 1.5WTE Clinical Psychologists to work with Looked After Children (existing provision, allocated long-term funding) • 1.0WTE CAMHS Nurse to work with the Youth Offending Service , plus new outreach counselling post from Hounslow Youth Counselling Service. Forensic CAMHS service also in place from 2019 • Emotional Wellbeing Service provided by Barnardo's as part of the Child Sexual Abuse Hub established in 2018 • New counselling provision for Care Leavers from Hounslow Youth Counselling Service, started April 2019 10
What’s in the plan for 2019/20? Priority Area Plans for 2019/20 Early Help & Access • Implementation of Mental Health Support Teams in schools • Scope opportunities for online counselling platforms e.g. Kooth, Healios Learning Disabilities & • Continue efforts to recruit specialist staff following the Neurodevelopmental new investment to address the waiting time Disorders • Recommissioning the behaviour support service with increased capacity for early intervention Crisis Care • Continue to engage with NMOC project to reduce Tier 4 admissions and use the savings to further develop the Alliance Team with increased staffing and a crisis line. Vulnerable Groups • Review outcomes of targeted services to support continued investment • Refresh needs analysis 11
How do we compare? • Exceeding our access target ; unlike many other London boroughs/ other areas nationally • Shorter waiting times for Tier 2 CAMHS than national average • Shorter waiting times for Tier 3 CAMHS than national average • Waiting times for neurodevelopmental assessments are slightly worse than the national average • Fewer admissions to Tier 4 beds than other London boroughs • Data quality has significantly improved in this area and the Trust is now able to demonstrate on a monthly basis that clinical outcomes are improving consistently between referral and discharge. Year to date data for Hounslow CCG indicates 99.3% of discharged cases had outcome measures completed and 66.7% showed improvement in clinical outcomes. • Increased funding for Early Intervention through Mental Health Support Teams- one of just 25 sites nationally and good practice highlighted through national attention. 12
What still needs to be improved? • Bringing down waiting times for particular services • Overcoming workforce shortages and recruitment challenges – this is now the main limiting factor rather than funding • Focussing on health inequalities and vulnerable groups • Continuing to engage with young people , families and partner organisations • Exploring opportunities for use of digital platforms to increase access 13
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