Milton Keynes Council Democratic Services, Civic Offices 1 Saxon Gate East Milton Keynes MK9 3EJ

Tel: Milton Keynes (01908) 691691 Fax: (01908) 252456 Hays DX 31406 Milton Keynes 1

Democratic Services

www.milton-keynes.gov.uk/scrutiny

31 OCTOBER 2017

19.00

COUNCIL CHAMBER, CIVIC OFFICES

ADDITIONAL PAPERS

CHILDREN AND YOUNG PEOPLE COMMITTEE

ITEM 7b - Mental Health, One Year On

(Pages 1 – 11)

For more information about the meeting please contact Dwight McKenzie on

Tel: (01908) 252177 or e-mail: Dwight.McKenzie@milton-keynes.gov.uk

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Children & Young People Committee

2017 - 18

MENTAL HEALTH – ONE YEAR ON

http://www.milton-keynes.gov.uk/your-council-and- elections/councillors-and-committees/overview-and-scrutiny

Democratic Services

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INTRODUCTION

1 At its meeting on 10 February 2016 the Committee considered three issues relating to the mental health of children and young people in Milton Keynes viz:

What was working well in achieving good outcomes

What were the main areas of concern and how are they being addressed

What can the Council do to further improve the health and wellbeing of young people

2 The following organisations were represented and made presentations

Central and North West London NHS Foundation Trust (CNWL) Dr Renu Daryanani (CAMHS consultant), Jane Taylor (Interim Service Manager) and Pete Raimes (Service Director for Mental Health, Milton Keynes)

Milton Keynes Clinical Commissioning Group (CCG) Hannah Pugliese (Children, Young People & Maternity Commissioner) and Amanda Farr (Joint Commissioner, Children and Families)

Milton Keynes Council Tracey Chapman and Caroline Marriott (Head of Delivery, Special Educational Needs & Disability) 3 All three organisation have invited to update their presentations as a means of

reviewing progress on areas of concern since February last year.

CAMHS PROGRESS TO DATE

Report prepared by Tryone Blackford-Swaries, new Service Director for Milton Keynes and Jane Tayor

Access

4 There have been a number of significant changes in the specialist CAMHS provision over the last year. The Service has been working towards a single point of access and away from the tiered service with its multiple access points. Clear specialist care pathways are being developed and a range of support and liaison posts have been developed to in reach into the YOT, SEND and LAC services:

• New mental health posts in the Special Educational Needs and Disabilities team

to strengthen early identification and support

• New arrangements agreed for looked after children including foster carer

support- recruitment commenced

• New arrangements in place in the Youth Offending Team

Specialist CAMHS have also been working towards the Choice and Partnership

Approach (CAPA) model and includes the development of the Children’s and Young people’s (CYP) IAPT pathway offering NICE compliant therapeutic interventions. A schematic of the overall model and pathways is provided below.

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Waiting lists have been maintained below 18 weeks since the beginning of 2016.

This remains a significant improvement from 28 weeks + in 2015.

Social Care now has open access to a duty and referral system between 9-5 Monday to Friday for consultation.

From June 2017 the service has offered initial assessment & screening appointments in six Children & Family Centres across Milton Keynes, increasing access & social inclusion.

Estates

A new unified team base was created at Eaglestone in April 2017. The service is also operating from a number of Children and Family centres has also increased clinical space capacity and presence across MK. The team was also transformed in terms of IT infrastructure and staff are now supplied with laptops which allows for greater flexibility in terms of clinical administration functions and working from different locations.

Tier 4 – Urgent Care

The Liaison and intensive support team (LIST) is established and delivering access to 24/7 CYP Mental Health Services. The service is now offering up to 4 weeks of home support for young people in crisis which provides an alternative to inpatient stay in out of area units. The CAMHS service also actively supports the discharge of young people from Tier 4 services which has had a positive effect on the average length of stay.

ADHD

Specialist CAMHS has developed new ways of working regarding medical cover with the introduction of Non-medical prescribers (NMP) and the development of ADHD clinic in preparation for the specialist pathways. This has improved access times for medical review.

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Recruitment

Specialist CAMHS have successfully recruited into most of the vacant posts with the exception of the medical team. Two new Rotational development nursing posts have been created and are currently 12 months into their programme and are on track to be successful in obtaining their band 6 speciality CAMHS nurse posts end of 2018.

There are risks associated with the CNWL CAMHS transformation which are being

managed in partnership with the CCG as part of the Local Transformation Programme. High level risks include:

Recruitment of quality staff to Medical posts

Maintaining capacity while implementing and training for CYP IAPT

Reduction in the budget of £200k in 2018/19

High levels of expectations from stakeholders

What MKC could do to further improve the mental health and well being of children and young people?

1. Continue to provide strong leadership in order to develop integrated services

across the system

Since last year CNWL and MKC senior managers have initiated an Operational

contract review meeting to strengthen joint working arrangements and initiatives

CAMHS multi-agency complex case reviews have been initiated over the year

and we hope this will continue.

2. Continue to work together for a whole systems approach to supporting early

intervention, and the Tier 2 contract- current contract ends April 2017.

CNWL remains a key member of the CAMHS LTP. There are emerging plans for

a schools trading offer which CNWL will fully support as this remains a key

preventative initiative.

Urgent Care: Support to develop a local crisis bed to avoid admissions to the

Campbell Centre could be explored with MKC. This could form part of an STP

future bid. Admissions to the Campbell Centre as a place of safety continues to

provide a better patient experience, but is not ideal.

3. MKC to continue to take an active role in establishing MK as a destination to

work and live in order to encouraging key workers to consider Milton

Keynes.

Housing schemes to attract key professionals - nurses, allied health

professionals etc

As part of the STP forge closer links with universities to develop trainee

placements in provider organisations eg psychologists, therapists, nursing

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Supporting a partnership with the new Bucks University medical school at

MHUH. Psychiatry is featured and it would be good for targeting CAMHS

training and placements as part of a recruitment strategy for MK.

4. View the issues with estates as a whole system problem and commit to work

together to resolve, and where possible consider integrated teams being

located together

This has been progressed in year with CAMHS working out of Children and

Family Centres. There is a wider ambition of having health, mental health,

children and young people agencies and social care on one footprint as this

would yield significant benefits. This work is progressing through the joint work

between commissioner and provider agencies to see what can be achieved.

MILTON KEYNES CLINICAL COMMISSIONING GROUP Report prepared by Amanda Farr The background

Significant work undertaken in Milton Keynes :

o Internal review undertaken by CNWL, provider of specialist mental health services

o Pathway review, 2015- undertaken by MKC and MKCCG o System wide transformation plan

Milton Keynes Children & Young People’s Mental Health & Wellbeing Local Transformation Plan (MKLTP):

o Identifies 9 key priorities o Sets out how these will be addressed over 5 years.

Delivery of the MKLTP is monitored through the Children and Young Peoples Mental Health and Wellbeing Transformation Delivery Board (LTP Delivery Board). This Board is accountable to Health and Wellbeing Board (HWB) and to the CCG for financial decision making. What do Children and Young People say…

• They want to talk about their feelings

• They want support to be available early to stop things getting worse

• They want schools to have a programme which includes information about relationships, feelings friends, partners

• That they hide their feelings because they are ashamed about how they sometimes feel

• Sexual inequality and stereotyping is an issue for them

• They want help from people who care about them and understand them

• That it’s really difficult to find information about mental health organisations in Milton Keynes. They thought information should be available in a range of formats and easier to find.

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• The service should be homely and private:

• They want a service which offers choice and flexibility.

They want the service to be easily accessible whilst also offering privacy and confidentiality What has been achieved to date

• Early help

– ‘Incredible Years’ parenting training programme implemented in Children and Family Centres, to support parents with emotional wellbeing and mental health difficulties

– SMILE YMK are delivering new sessions in MK College , Children and Family Practice North, the Rivers Centre and MK Academy.

– Community Foundation is coordinating information about existing services provided by the Community and Voluntary Sector. Further breakfast meeting planned in July to look at emerging information, identified gaps and possible solutions for addressing these.

• Changes to specialist CAMHS

– Waiting list reduced – assessment clinics being delivered in all 4 children and family centres

– New duty and referral system in place

– Integrated Care Pathway agreed with MKUH for care of CYP in crisis accessing mental health care through the hospital- working well

– Access to 24/7 assessment for young people with urgent needs

– Up to 4 weeks of home support for young people in crisis

– Processes for monitoring young people who need care in a hospital out of area have been strengthened and a new protocol is in place to support seamless discharges and transition to community services

– Waiting list for urgent eating disorder referrals less that 1 week

• Specialist care for women who are pregnant or have given birth in the past year.

– New specialist team in place

– Multiagency training programme launched

– Multiagency care pathway developed and launched

What is happening now

• Early help

– Breakfast Meeting - Continuing to work with Community Foundation to plan the breakfast event. The agenda will be to map current provision, identify gaps and think creatively about how partners could work together to manage and improve the system

– Arts Project – Developing a proposal with Public Health to work with the Cultural Education Partnership who will commission a film maker to work with

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children and young people to capture differing views and perceptions of emotional wellbeing and mental health

– Teaching Conference – Working with MKC Governor Services to run a schools conference held in July 2017 focussing on the emotional wellbeing and mental health of children and young people in school. As a result schools are now appointing an emotional wellbeing and mental health governor. In addition a working group has been established to address training needs and respond to local and national initiatives.

• Changes to specialist CAMHS- new model of provision

– Single point of access for Children & Young People to Specialist Mental Health Service

– Integrated specialist provision, screening and triage of all referrals

– Targeted Brief Intervention Service (principles of CYP IAPT)

– Specialist Care Pathways (Mood Disorders, Psychosis, Neuro Psychiatric, Dialectical Behavioural Therapy)

• Liaison and support for non mental health services

– New mental health posts in the SEND team to strengthen early identification and support

– New arrangements agreed for looked after children - a Primary Mental Health worker has now been appointed

– New arrangements in place in the YOT

– Aim2 Training is completed with a virtual team established. Agreed multi agency group in place to manage demand and evaluate impact of the project meeting in June

– Working with specialist commissioners to develop a regional forensic CAMH service

What still needs to be done

• Early help

– Strengthening the offer in primary care, universal services, schools

– Improving the links between early help services and specialist services

– Coordinating the landscape of support and filling the gaps in community and voluntary sector provision

• Changes to specialist CAMHS- new model of provision

– Complete transformation to the new model

– Including delivery of CYP IAPT

– Develop a traded offer

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• Complex and Challenging behaviour (ASD/ ADHD/ Conduct Disorder/ LD/ no

diagnosis)

– Long waiting lists for diagnosing ASD

– Limited post diagnostic support available – not meeting varied population needs:

– Perception that need is not being addressed early- escalation of need, increased crisis

– Increased spend – high cost low volume

– Friction between agencies

– Increased demand and complexity of need

– Good understanding of issues at front line manager/ practitioner level but lack of robust assessment of need and cost to the system

– National driver to get this right- Lenehan Report, Transforming Care, High Needs Review

Other points to note are that there are still no Tier 4 beds in Milton Keynes. Children and young people go to Northampton, or further afield if there is no bed. The possibility of a local telephone hotline has not progressed. The service has explored Kooth, an online counselling and emotional well-being platform for children and young people, accessible through mobile, tablet and desktop. But the cost – at £60,000 p.a. - is beyond current resources. MILTON KEYNES SPECIAL EDUCATIONAL NEEDS AND DISABILITY The update presentation attached has been prepared by Caroline Marriott

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