North West London Clinical Commissioning Groups · North West London Clinical Commissioning Groups...
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North West London Clinical Commissioning Groups Children and Young People’s Mental Health and Wellbeing Strategy and Transformation Plan In response to Future in Mind First Published October 2015 Refreshed October 2016 and October 2017 Supported by the Mental Health and Wellbeing Team– The Mental Health and Wellbeing Strategy for North West London
Transcript of North West London Clinical Commissioning Groups · North West London Clinical Commissioning Groups...
North West London Clinical Commissioning Groups
Children and Young People’s Mental Health and Wellbeing Strategy and Transformation
Plan
In response to Future in Mind
First Published October 2015 Refreshed October 2016 and October 2017
Supported by the Mental Health and Wellbeing Team– The Mental Health and
Wellbeing Strategy for North West London
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Declarations of Support
Brent
Name: Councillor Krupesh Hirani Position/Organisation: Lead Member for Adults, Health and Wellbeing - Member for Dudden Hill Ward (Labour) Date:
Name: Sarah Basham Position/Organisation: Brent CCG Mental Health GP Lead Date:
Central London
Name: Cllr Heather Acton
Position/Organisation: Deputy Chair Health and Well-being Board Date: 30.10.17
Name: Jules Martin
Position/Organisation: Managing Director NHS Central London CCG Date 30.10.17
Ealing
Name: Dr Mohini Parmar Position/Organisation: CHAIR, NHS EALING CCG Date:
Name: Cllr Julian Bell Position/Organisation: Leader, London Borough of Ealing; Chair, Ealing Health & Well-being Board Date:
Hammersmith and Fulham
Name: Cllr Ben Coleman
Position/Organisation: Chair Health and Well-being Board.
Date:
Name: Janet Cree
Position/Organisation: Managing Director, NHS Hammersmith and Fulham CCG
Date:
Harrow
Name: Chris Spencer
Position/Organisation: Corporate Director of People Services Harrow Council
Date:
Name: Paul Jenkins
Position/Organisation: Chair Date: 31.10.17
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Hillingdon
Name: Dr Ian Goodman Position/Organisation: Chair
Date: 17.10.17
Name: Position/Organisation: Health and Wellbeing Board Endorsement Agreed via Email Date: 17.10.17
Hounslow
Name: Mary Clegg
Position/Organisation: Managing Director Hounslow CCG Date: 24.10.17
Name: Councillor Steve Curran
Position/Organisation: Leader of Hounslow Council and Chair of Hounslow Health & Wellbeing Board Date: 24.10.17
West London
Name: Cllr Charles Williams
Position/Organisation: : Chair of Health and Wellbeing Board for Kensington and Chelsea
Date:
Name: Louise Proctor
Position/Organisation: Managing Director, NHS West London CCG Date: 30.10.17
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Table of Contents
1.0
Executive Summary
Page 5
2.0
Supporting Improved Mental Health In NW London
Page 6
3.0
Understanding Local Need
Page 8
4.0
Service Provision
Page 15
5.0
Our Shared Priorities
Page 17
5.1 Priority 1: Waiting Times Page 18
5.2 Priority 2: Community Eating Disorder Service Page 23
5.3 Priority 3: Redesigning the System Page 29
5.4 Priority 4: Vulnerable Groups Page 36
5.5 Priority 5: Crisis and Urgent Care Page 44
6.0
Emerging Local and National Initiatives
Page 49
7.0
Enablers
Page 51
Enabler 1: Coproduction Page 51
Enabler2: Work Force and Training Page 52
8.0
Equalities
Page 56
9.0
Governance and Risk
Page 57
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1.0 Refresh 2017/18 Executive Summary
This document is a refresh of the 2015 and 2016 North West London (NW London)
Children and Young People’s (CYP) Mental Health and Wellbeing Strategy and
Transformation Plan. The plan provides detailed assurance to local and national
stakeholders we are working in partnership across health, local authorities,
education, the third sector and criminal justice system to provide high quality
intervention and support to CYP who require mental health and emotional wellbeing
services. The Transformation Plan is a core component, of the North West London
Sustainability Plan (STP) 1 which sets out the vision to support the local population to
be well and live well. Key to achieving this vision is to deliver fundamental
improvements for CYP. The transformation plan forms the basis of the overarching
CYP NW London STP Transformation Programme.
Since the publication of the original plan in 2015 we have made significant progress
towards our defined aim of promoting emotional wellbeing and ensuring that children
and young people, who experience mental health issues, have timely access to high
quality intervention and support. A number of new services and quality improvement
initiatives have been successfully implemented including a Community Eating
Disorder Service, an Out of Hours Crisis Service and a range of local school’s mental
health prevention and early intervention programmes.
The 2017 Transformation Plan switches focus from individual service improvement
and implementation to whole systems redesign with the remodelling of the entire
children and young people’s emotional health and wellbeing service delivery
framework together with the implementation of a fully integrated 24-hour crisis service
and reconfiguration of services aimed at vulnerable groups such as young people
involved in the criminal justice system and those with Autistic Spectrum Disorder
(ASD) and Learning Disabilities (LD).
The ambition of our transformation programme is to ensure by 2021 every child and
young person in NW London can access appropriate needs based, person centred
mental health and emotional wellbeing support that significantly improves outcomes.
The transformation programme is underpinned by key enablers; workforce
development and assessment of local need. At the heart of the programme is
coproduction ensuring the needs, wishes and preferences of children, young people
and their families and carers are central to the design and development of all
pathways and services. In line with the ambition of Future In Mind2, our vision is
provide high quality, equitable intervention that achieves the same outcomes no
matter where in the system help is sought.
1
NW London Sustainability and Transformation Plan November 2016 https://www.healthiernorthwestlondon.nhs.uk/sites/nhsnwlondon/files/documents/nwl_stp_october_submission_summary_v01.pdf 2 Future in Mind DoH/NHSE 2015
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf
6
2.0 Supporting Improved Mental Health and Wellbeing for Children and Young People in North West London
In February 2015 eight NW London
CCGs launched ‘Like Minded’ – the NW
London strategy for mental health and
wellbeing. As part of this strategy all eight
CCG’s pledged to work together to
deliver the ambition of Future in Mind2. A
joint Transformation Plan was developed
for NW London that defines shared
priorities and describes initiatives
implemented locally.
Although collaboration is at the core of how we work, we recognise that each borough has individual needs and infrastructure. For clarity we are not proposing that there is any cross-subsidisation across NW London. The funding outlined in this plan is ear-marked for each CCG, and will be invested in the children and young people in each locality.
The Transformation programme is a unique opportunity to design a new system
which, by 2021 will look radically different from our starting point in 2015. There are
many clear benefits to working in partnership to address our mental health priorities
across NW London. These include:
- Having a clearer picture of emotional and mental health needs across NW
London giving us a richer understanding of the demands on services, the
challenges faced, and the areas in which we can benefit from working together.
- Developing economies of scale allowing us to pool resources, jointly invest in
project management, commissioning of needs assessments, and buying of
services such as communication campaigns.
- Sharing of learning from the many different initiatives and high quality services
implemented in each area.
- Reducing duplication and promoting efficient working and business practices.
- Delivering equitable service provision and access across NW London ensuring
that CYP receive high quality mental health care and support, irrespective of
which borough they live in.
- Collaborative working to develop consistent pathways and services that deliver
the same outcomes across NW London.
2 Future in Mind DoH/NHSE 2015
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf
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Alongside our collaborative approach, we continue to keep a local focus to ensure the
specific needs of each borough are reflected in our overall plans. Five priorities of
our Transformation Plan are shared across all our CCGs; the individualised
approaches to delivering these priorities are set out in detail in each CCG’s local
annex: -
Annex A: Brent CCG
Annex B: Central London CCG
Annex C: Ealing CCG
Annex D: Hammersmith and Fulham CCG
Annex E: Harrow CCG
Annex F: Hillingdon CCG
Annex G: Hounslow CCG
Annex H: West London CCG
We previously set out plans detailing how we would achieve our ambition in 2015/16
and 2016/17. This plan builds on previous initiatives, defining our work programme
for 2017/2018 and beyond. Our earlier plans aimed to get the basics right –
embedding co-production, refreshing our needs assessments and undertaking
workforce needs analysis. We have focused on reducing the waiting times for
specialist CAMHS, enabling access to early help and prevention intervention
programmes close to home, implementing a crisis out of hours’ support service and
improving access to community Eating Disorder (ED) services.
The next phase of the programme looks to shape future services and drive quality by
delivering whole systems transformation. The programme aims to provide integrated
care (Health, social care, criminal justice, education and third sector) which enables
children, young people, their families and carers to access the right support and
intervention at the right time. This is an evolving plan which is adapted to meet local,
regional and national specification, changes and challenges.
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3.0 Understanding local need
Understanding the individual needs of each CCG as well as the requirements of NW
London as a whole, is essential to define the scope and scale of transformation
required to fundamentally improve our offer to CYP. The NW London CYP population
is set out in Table 1. For six of our eight boroughs, the boundaries are adjacent. West
London CCG covers the borough of Kensington and Chelsea, and the Queens Park
and Paddington areas of Westminster. Central London CCG covers the remainder of
Westminster.
Population and demographic data in North West London
21% of the NW London population is aged under 18. Five boroughs (Brent, Ealing,
Harrow, Hillingdon, and Hounslow) all have populations (23%) slightly above the
London and English average (22.5% and 21% respectively).
Table 1: Population and demographic data in NWL3
Key population details
Brent Ealing H&F Harrow H’don H’slow WL CCG CL CCG
TOTAL NWL
Number of children
2015 73,325 80,520 33,705 57,200 69,860 61,945 40,175 27,480 444,210
Number of Children
2016 74,016 80,256 33,777 56,642 69,207 61,496 40,339 28,124 443,857
% of increase
1% -0.3% 0.2% -0.1% -0.9% -0.7% 0.4% 2% -0.08%
Number of school
Children 2017
51,262 59,313 27,588 39,877 56,105 45,163 26,124* 31,347** 336,779
* This figure shows number of school children in Kensington & Chelsea Borough ** This figure shows number of school children in Westminster Borough
Prevalence of Mental Health and Emotional Wellbeing Issues in NW London
Table 2 and 3 demonstrate the estimated prevalence of mental health disorders in
children and young people in NW London. Prevalence is variable with two boroughs
in line with the English and London average (Hillingdon and Hounslow), 3 significantly
lower (Kensington and Chelsea, Harrow and Hammersmith and Fulham) and three
with higher prevalence rates (Brent, Ealing and Westminster). In addition, prevalence
of emotional disorders are slightly higher than London and national averages in Brent
and Westminster, conduct disorders higher in Brent and Ealing and hyperkinetic
disorders higher in Brent, Ealing, Hillingdon and Hounslow.
3
National Statistics January 2017 Special educational needs in England: January 2017
Local authority tables: SFR37/2017- https://www.gov.uk/government/statistics/ special-
educational-needs-in-england-january-2017
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Table 2: Estimated Numbers of Mental Health Disorders4
Estimated Numbers of Mental Health Disorders (Public Health England, 2014)
Brent Ealing H&F
Harrow
H’don
H’slow K&C West-
minster TOTAL NWL
Any mental health
disorders 4,638 4,767 1,888 3,187 4,108 3,534 2,320 1,721 26,163
Emotional Disorders
1,783 1,841 745 1,237 1,576 1,347 920 687 10,136
Conduct Disorders
2,885 2,924 1,140 1,920 2,503 2,164 1,395 1,047 15,978
Hyperkinetic Disorders
787 797 307 521 687 595 376 280 4,350
Table 3: Estimated % of Mental Health Disorders4
Self-Harm
Self-harm is also more common amongst young people with mental health needs.
Among 11-16 year olds, over a quarter of those with emotional disorders and around
a fifth of those with conduct or hyperkinetic disorders or depression said that they had
tried to harm themselves5.
In NW London rates for CYP admitted to hospital because of self-harm are
significantly lower than the English average for all 8 CCG’s (Table 5) with either no
trend or a decreasing trend noted in 2015/164.
4Public Health England Fingertips 2015: https://fingertips.phe.org.uk/profile-group/mental-
health/profile/cypmh/data#page/1/gid/1938133090/pat/120/ati/153/are/E38000020 5ONS (2005). Mental Health of Children and Young People in Great Britain. Accessed at
http://www.hscic.gov.uk/catalogue/PUB06116/ment-heal-chil-youn-peop-gb-2004-rep2.pdf
Estimated % of Mental Health Disorders (GP registered population aged 5-16)
NWL average
Brent Ealing H&F Harrow H’don H’slow K&C W’minst
er NWL
average
% of any mental health
disorders 10 9.4 8.9 8.8 9.3 9.3 8.8 9.3 9.2
England rate in 2015= 9.2%; London rate in 2015= 9.3%
% of Emotional Disorders
3.8 3.6 3.5 3.4 3.6 3.5 3.5 3.7 3.6
England rate in 2015= 3.6%; London rate in 2015= 3.6%
% of Conduct Disorders
6.2 5.8 5.4 5.3 5.7 5.7 5.3 5.7 5.6
England rate in 2015= 5.6%; London rate in 2015= 5.7%
% of Hyperkinetic
Disorders 1.7 1.6 1.4 1.4 1.6 1.6 1.4 1.5 1.5
England rate in 2015= 1.5%; London rate in 2015= 1.5%
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Table 5: Self-Harm Hospital Admissions4
Looked After Children
There are a number of specialised areas of mental health needs that are relevant in
certain areas of NWL. For example, some areas have large number of looked after
children (LAC). The rates of looked after children vary across NW London (58 in
Hammersmith and Fulham, 32 in Harrow) and are lower than the national or very
slightly higher London average (60 and 51 respectively) the number of LAC where a
significant cause for concern has been identified is significantly higher than the
national and London average in Harrow, Brent and Hounslow. National research has
found that among LAC, 38%-49% (depending on age) have a mental health disorder.
Table 6: Looked After Children 4, 6
Looked After Children
Brent Ealing H&F Harrow H’don H’slow K&C W’minster
NWL
average
Aged under
18 years (per
10,000 in
2015/16)
45 46 58 32 49 45 37 39 43.88
England rate in 2015/16= 60; London rate in 2015/16= 51 (per 10,000 children under 18 years)
% of LAC
where there
is cause for
concern in
2015/16
44.7 25.7 20.9 40.7 32.8 43.2 31.4 27 33.3
England rate in 2015/16= 37.8%; London rate in 2015/16= 32.9%
Children with Special Educational Needs Children with special educational needs may be at higher risk
of developing emotional and mental health issues. Across NWL, the percentage of
school aged children with special education needs, including autistic spectrum
disorders, ranges widely as demonstrated in the Table 7.
4 Public Health England Fingertips 2015: https://fingertips.phe.org.uk/profile-group/mental-
health/profile/cypmh/data#page/1/gid/1938133090/pat/120/ati/153/are/E38000020 6 National Statistics September 2016 Children looked after in England including adoption:
2015 to 2016 Local authority tables: SFR41/2016- Table LAA1 https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2015-to-2016
Self-Harm Hospital Admissions
Brent Ealing H&F Harrow H’don H’slow K&C W’minster
NWL average
Aged 10-24 years (per 100,000 in 2015/16)
100.7 219.3 136.1 163.6 207.9 349.9 160.4 137.5 184.4
England rate in 2015/16= 422.8 (per 100,000)
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Rates in Hammersmith and Fulham, Hounslow and Westminster are higher than both
the English and London average. The percentage of children with autism known to
schools is slightly higher in Hammersmith and Fulham and Hillingdon. The
percentage of children with a learning disability is lower than the English and National
average across NW London.
Table 7: Children with Special Education Needs 4,7
Criminal Justice and Mental Health
Rates for first time entry to the youth justice system across NW London are shown
Table 8 below. First time entrants into the criminal justice system are significantly
higher than the London average in Hammersmith and Fulham, Brent, Ealing
Hounslow and Kensington and Chelsea and all NWL boroughs have rates above the
national average.
Table 8: First time entrants to youth justice system aged 10-174
4
Public Health England Fingertips 2014/17: https://fingertips.phe.org.uk/profile-group/mental-health/profile/cypmh/data#page/1/gid/1938133090/pat/120/ati/153/are/E38000020 7 National Statistics, Special educational needs in England: January 2017Local authority
tables:SFR37/2017- Table15 https://www.gov.uk/government/statistics/special-educational-needs-in-england-january-2017
Children with Special Education Needs
Brent Ealing H&F Harrow H’don H’slow K&C
W’ minster
NWL average
% of school pupils with SEN
12.5 13.8 14.8 12.6 13.7 16.5 12 16.2 14
England SEN rate in 2017= 14.4%; London SEN rate in 2017= 14.3%
% of children with Autism known to schools in 2014
0.94 0.76 1.28 0.99 1.18 0.93 0.5 0.67 0.91
England Autism rate in 2014= 1.08%; London Autism rate in 2014= 1.15%
% of school aged pupils with LD in 2016
4.3 4.4 5.3 3.3 3.7 4.9 3.7 4.7 4.3
England LD rate in 2016= 5.3%; London LD rate in 2016= 4.4%
First time entrants to youth justice system aged 10-17
Brent Ealing H&F Harrow H’don H’low K&C W’minster
NWL average
First time entrants to the youth justice system: aged 10-17 (per 100,000)
434 484 662 336 329 487 431 388 443.1
London rate in 2016= 407 (per 100,000 aged 10-17) National rate in 2016= 327 (per 100,000 aged 10-17)
12
Admission Rates Since 2015 admission rates across NW London have decreased by 23%. Within each
borough rates have either reduced considerably (West London, Hillingdon, Brent
Hammersmith and Fulham) stayed the same (Central London, Harrow) or slightly
increased (Hounslow and Ealing). All 8 CCG’s are either in line or less than the
national average admission rates per 100,000 children (85) with Hillingdon and Brent
marginally above the London average of 82.
Table 9: Admission Rates for a Mental Health Disorder 2014/15 and 2016/174
North West London Needs Assessment.
At the beginning of the transformation programme we recognised that our evaluation
of local need and the prevalence of risk factors linked to poor mental health were
largely out of date. To better understand our population and NW London mental
health and emotional wellbeing requirements, the Anna Freud Centre (AFC) was
commissioned to undertake needs assessment by seven of the eight NW London
CCG’s in 2016. Except for Hillingdon, who had their own joint strategic needs
assessment (JSNA) in place at that time, each locality had an individual assessment.
The results of the assessment were disseminated to each CCG in the form of two
reports; an initial needs assessment and a final report. Seven CCG’s, (except
Harrow), held a local strategic seminar. Facilitated by AFC this was an opportunity for
a wide range of professionals and agencies to come together to discuss the main
recommendations of the report. In 2017 Hillingdon commissioned AFC to undertake
a detailed local assessment.
The outputs of this assessment have been used to underpin the transformation
programme and shape the refresh of the NW London Transformation Plan. The way
in which the assessment influenced local service development is outlined in the
individual Annex for each CCG. The impact of the recommendations on the
development of our new model of care is discussed in section 6.2.
4
Public Health England Fingertips 2014/17: https://fingertips.phe.org.uk/profile-group/mental-
health/profile/cypmh/data#page/1/gid/1938133090/pat/120/ati/153/are/E38000020
Admissions
CNWL WLMHT
Central
London
West
London H’don Brent Harrow H&F Ealing H’slow
Total
NWL
Number of admissions for mental health conditions
2014/15 26 33 55 66 31 45 51 31 338
2015/16 22 22 43 44 48 16 46 39 280
2016/17 23 19 36 38 29 16 55 41 260
Admission rate per 10,000 children
2015/16 74 52 85 84 67 82 76 70
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The plan and services delivered will be adapted to reflect changing local
requirements. For example, the Grenfell fire national disaster which occurred in West
London CCG in 2017 has required rapid reorganisation of local CAMHS services to
ensure vulnerable CYP can quickly access help and intervention according to their
needs.
Key NW London Challenges
Analysis of local data and our needs assessment have enabled several key
challenges to be identified. These challenges are being addresses as part of our
transformation programme:
1. We have high rates of young people entering the criminal justice system;
2. In some boroughs, we have a significant number of looked after children, a
most vulnerable group, whose complex and multiple needs require to be taken
into consideration;
3. We have a high number of children with special educational needs in some
areas;
4. Children, young people and their parents and carers find it difficult to navigate
the various components of our complex system;
5. There are long waits for Child and Adolescent Mental Health Services
(CAMHS) in some areas with no meaningful support provided whilst they are
waiting for an assessment;
6. Waiting times for an autism assessment are improving but access to post
diagnostic help and support is variable;
7. A significant proportion of young people who require inpatient care must
access treatment outside of London, particularly those who have learning
disabilities or have complex needs;
8. There is a lack of integration across many services (health, social care,
education, third sector).
As our transformation programme has progressed, the complexity of delivering large-
scale change across 8 CCG’s, 8 local authorities, and 743 educational
establishments (Table 10 on page 14) has become apparent. Learning from our
experiences, we have begun to consider how best we can adapt our programme to
drive change in the most efficient and effective way. Clearly identifying the elements
of the transformation plan that work best at local level and the components of
transformation that are best delivered on a system wide basis, will enable us to
develop the robust road map through which we will deliver change. Our change in
thinking has led to a reconsideration of the way we initially proposed to deliver some
elements of our transformation programme together with a review of our priorities.
This has resulted in a detailed rewrite of our transformation plan with significant
changes in timescales in some areas.
14
Table 10: Numbers of schools in NWL7
ocal Authority
State-funded nursery
State-funded primary
(1)(2)
State-funded
secondary (1)(3)
Special Pupil
referral units
(5)
Independent All
schools State-
funded (4)
Non-maintained
Total
Hammersmith and Fulham 4 37 12 4 1 5 3 21 82
Kensington and Chelsea 4 26 6 2 0 2 1 44 83
Westminster 4 41 12 3 0 3 1 29 90
Brent 4 60 15 4 0 4 2 16 101
Ealing 4 68 14 6 0 6 2 22 116
Harrow 1 40 12 4 0 4 2 13 72
Hillingdon 1 69 21 7 2 9 1 9 110
Hounslow 0 54 17 5 0 5 1 12 89
395 109 35
743
7
National Statistics January 2016 Schools, pupils and their characteristics Local authority and
regional tables: SFR20/2016- Table 7a https://www.gov.uk/government/statistics/schools-
pupils-and-their-characteristics-january-2016
15
4.0 Service Provision
4.1.1 Core Service – Community General and Specialist Children and
Adolescent Mental Health Services (CAMHS)
In NW London, a significant proportion of NHS funded Children and Young People’s
Mental Health Services are delivered by community and specialist CAMHS who
provide multi-disciplinary assessment together with therapeutic and psycho-
pharmacological intervention for children and young people up to the age of 18 years,
where there is a likelihood of a severe mental health disorder and/or where
symptoms, distress, and the degree of social and/or functional impairment is serious.
In addition, the CAMHS provide professional consultation and liaison with other
services and professions such as paediatric liaison, social care, paediatric services,
criminal justice and out of hours’ services. In some areas, there is a partnership
approach to service delivery with third sector providers.
Our NW London CAMHS teams consist of consultant child and adolescent
psychiatrists, clinical psychologists, child psychotherapists, systemic family
therapists, clinical nurse specialists, junior doctors (from the CAMHS medical training
scheme) and administration and managerial staff. Referrals are made by any
professional working with a child, young person or their family. The transformation
programme has resulted in a significant staffing increase set out in Table 11 below.
Table 11: CAMHS Staffing Increase funded by Transformation money September 20178
8 Data provided by CNWL and WLMHT
Staffing (WTE) across NW London
CNWL WLMHT NWL
Recruited To be recruited
Recruited To be
recruited WTE
Consultant Psychiatry 1.1WTE 3WTE 0.9WTE -
Speciality Doctor 1WTE 0.3WTE
Clinical Psychology 9.1 WTE 3WTE 1.2WTE
Specialist Nursing 6.3WTE 14WTE 5.1WTE 10.3 WTE
Family Therapy 2.2WTE 2.6WTE -
Speech and Language - -
Occupational Therapy 1WTE - -
Dietetics 0.5WTE 0.3WTE -
Children’s Wellbeing Practitioners 1WTE 8WTE 12WTE
Assistant Psychologists 1WTE - 1.5 WTE
Participation Worker - 0.9WTE
Administrator 2WTE 1.5WTE 1WTE
Behavioural Analyst Post 4WTE 1WTE
Psychotherapist 1.3WTE 0.2WTE
Social Worker 1WTE
Mental Health Practitioner 1WTE
Paediatrician 1.2WTE
School Worker 1WTE
112.5 WTE
16
WTE= Whole Time Equivalent
Since the transformation plan was implemented in 2015 the total WTE staffing has
increased 66.3 WTE, with 46.2 additional posts due to be recruited.
4.2 Other Support for Mental Health
In NW London, we have numerous early intervention and prevention programmes
commissioned in each borough. The programmes deliver community and schools
based support focused on local mental health and emotional wellbeing needs. The
specific details are set out in each local annex (A-H). Examples include:
- Schools and educational early intervention and prevention programmes
- Early Years Programmes
- Digital and online access to help and support
- Infant mental health services
A wide range of agencies including primary care, schools, leisure services, voluntary
sector providers, acute hospital services, and health visiting can recognise issues
and provide basic support. As we develop our transformation programme we are
working in partnership with these agencies to improve the identification, provide
effective first line support and improve signposting to more intensive interventions to
ensure we make every contact count and have an adaptable and flexible community
support network in place.
Abuse and Neglect
Specialist CAMHS referrals are accepted for any child or young person who has been
abused, under gone trauma or experienced neglect.
In 2016/17 NW London were engaged with the London Child Sexual Assault (CSA)
project looking at how best we could meet the needs of this group of vulnerable
children. The aim was to establish hubs initially, but look to eventually develop plans
for a specialist Child House.
The programme has recently received additional funding and moved to the Healthy
London Partnership. We will be working in collaboration as the programme evolves.
17
5.0 Our Shared Priorities across NWL As outlined in our 2016 plan our original eight priorities were reduced to four shared
priorities. In our original 2015 plan priority areas, such as Needs Assessment, Co-
Production, Workforce Development and Embedding Future in Mind were identified
as separate elements of the programme. As the transformation programme
progressed it became apparent these areas were key enablers rather than individual
components of the transformation programme. Embedding Future in Mind underpins
the entire programme and was therefore omitted as an individual enabler. The needs
assessment element of our programme was addressed by the comprehensive needs
assessment carried out by the Anna Freud Centre which now supports our
programme delivery.
In 2016/17, we reviewed our programme and priorities, adding improving waiting
times as a key priority. As we reflected on our Learning Disability/
Neurodevelopmental Priority we recognised our focus was very narrow and did not
include other vulnerable groups identified as a risk in many NWL boroughs. We have
therefore expanded this priority to include all vulnerable groups including young
people that are at risk of or who are already involved with the criminal justice system
and Looked After Children (LAC).
Sustainability
As we move forward with our plan we are ensuring not only our services are fit for
purpose and deliver high quality care, but that they are financially viable and offer
value for money. As yet NHSE have not set out their funding plans post 2021. Long-
term service planning is therefore difficult to undertake at this stage.
Priority 2
Priority 3
Priority
4
Priority 5
Community Eating Disorder Service
Redesigning the System
Vulnerable Groups
Crisis and Urgent Care
Enabler 3
Enabler 1
Enabler 2
Needs Assessment
Co-production
Workforce Development
Delivering change across North West
London
Developing Infrastructure
Priority 1
Waiting Times
18
5.1 Priority One: Waiting Times
5.1.1 Funding
2016/17 2017/18 2018/19 2019/20
Central £83,903
Individual CCG Plans
Individual CCG Plans
Individual CCG Plans
West £102,128 Individual CCG Plans
Individual CCG Plans
Individual CCG Plans
H&F £44,278 Individual CCG Plans
Individual CCG Plans
Individual CCG Plans
Ealing £177,005 Individual CCG Plans
Individual CCG Plans
Individual CCG Plans
Hounslow £122,451 Individual CCG Plans
Individual CCG Plans
Individual CCG Plans
Hillingdon £128,379 Individual CCG Plans
Individual CCG Plans
Individual CCG Plans
Harrow £106,659 Individual CCG Plans
Individual CCG Plans
Individual CCG Plans
Brent £74,834 Individual CCG Plans
Individual CCG Plans
Individual CCG Plans
Additional NHSE Funding
5.1.2 Road Map
5.1.3 Our Ambition
In line with Future in Mind2 recommendations our aim is for minimal waiting times,
enabling CYP to rapidly access the right service at the right time.
5.1.4 Our Progress
In 2016/17 an additional £839,657 in funding was allocated by NHSE to NW London
CCG’s as part of a national initiative to improve waiting times. The funding was
allocated in two tranches. All CCGs received the first allocation of funding with the
second allocation dependant on defined reductions in waiting times.
2 Future in Mind DoH/NHSE 2015
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf
19
All CCG’s improved access although difficulty recruiting staff with the right skills in a
very short time scale and the inability to employ locum staff above the numbers
allocated by NHSE, meant Brent and Hammersmith and Fulham did not achieve
NHSE access targets. Neither CCG received the full allocation of funding. Action
plans were developed and are reported to and monitored by each CCG and NHSE to
ensure going forward expected targets are met. Tables 11, 12 and 13 below outline
the activity data for our community and specialist NHS Funded mental health services
in NW London compared to our 2014/15 baseline. Table 12 represents a snap shot of
referral data over the period of 1 month (June 2017). Table 14 defines the referral
pattern for each year.
Table 12: Waiting Times 2014/15 and 2016/178
Numbers and percentages of CYP that are seen within 4 weeks of referral, 5-11 weeks of referral, and over 11 weeks from referral.
8 Data provided by CNWL and WLMHT
Waiting Times
CNWL WLMHT
Central London
West London
H’don Brent H’ow H&F Ealing H’slow Total NWL
Referral – Assessment: Under 4 weeks
2014/15 26 (67%)
17 (61%)
10 (21%)
16 (30%)
8 (19%)
15 (56%)
3 (25%)
2 (8%)
97 (35%)
2016/17 35 (71%)
42 (64%)
37 (35%)
37 (46%)
24 (44%)
56 (76%)
98 (56%)
108 (53%)
437 (54%)
Referral – Assessment: 5 - 11 weeks
2014/15 7 (18%)
10 (36%)
9 (19%)
16 (27%)
28 (65%)
10 (37%)
4 (33%)
9 (35%)
93 (34%)
2016/17 13 (26%)
19 (29%)
24 (23%)
31 (39%)
23 (43%)
17 (23%)
66 (38%)
90 (44%)
283 (35%)
Referral to Assessment: over 11 weeks
2014/15 6 (15%)
1 (4%)
28 (60%)
22 (41%)
7 (16%)
2 (7%)
5 (42%)
15 (58%)
86 (31%)
2016/17 1 (2%)
5 (7%)
44 (42%)
12 (15%)
7 (9%)
1 (1%)
10 (8%)
7 (3%)
87 (10%)
Assessment to Treatment: Under 4 Weeks
2014/15 30 (83%)
12 (60%)
11 (46%)
23 (79%)
5 (83%)
17 (68%)
6 (67%)
8 (57%)
112 (69%)
2016/17 19 (79%)
36 (88%)
39 (72%)
49 (92%)
25 (71%)
30 (97%)
20 (83%)
35 (90%)
253 (82%)
Assessment to Treatment: 5 to 11 weeks
2014/15 5
(14%) 6
(30%) 9
(37%) 3
(10%) 0
(0%) 5
(20%) 1
(11%) 6
(43%)
35 (21%)
2016/17 2
(8%) 4
(10%) 9
(17%) 4
(8%) 8
(23%) 6
(16%) 4
(17%) 4
(10%)
41 (13%)
Assessment to Treatment: over 11 weeks
2014/15 1 (3%)
2 (10%)
3 (12%)
2 (22%)
0 (0%)
3 (12%)
2 (22%)
0 (0%)
16 (10%)
2016/17 3 (12%)
1 (2%)
6 (11%)
0 2 (6%)
0
1 (4%)
0 13 (4%)
20
Data from 2016/17 (Table 12) highlights improvements across NW London in terms
of the number of CYP who are assessed and treated in under 11 weeks. Despite a
34% increase in the numbers of children referred, 54% are now assessed within 4
weeks.
There have also been improvements (Table 13) in the length of time CYP must wait
between assessment and treatment with 95% offered treatment packages in less
than 11 weeks compared to 82% in 15/16. The number of CYP on the specialist
CAMHS waiting list has also reduced significantly (71%) although there is some
variability across NW London with three CCG’s West London, Ealing and Hounslow
showing increases.
As set out in each annex, individual CCG’s have mechanisms in place to address any
issues and ensure appropriate action plans are in place which are monitored and
reported to NHSE.
Table 13: Waiting Times Specialist and Urgent Care 2014/15 and 2016/178
Due to changes in data capture systems and processes this data is unable to be provided.
Referral Rates and waiting times Table 14 on page 21 sets out the number of referrals made and accepted. Although
the number of referrals accepted stayed relatively static (0.2% decrease), the picture
across NW London varied considerably with some boroughs experiencing significant
increases (Hounslow 38%, Hammersmith and Fulham 23%) in referrals accepted.
Increasing demand in specific areas has led to waiting time increases (Ealing and
Hounslow) in some localities. In West London the 36% increase in the number of
CYP on the waiting list is attributed to the Grenfell fire national disaster which has
resulted in significant numbers of new referrals in a very short space of time. These
unexpected and specific needs are being addressed by additional emergency
funding.
Compounding the increase in demand in some areas has been on-going recruitment
issues with difficulty filling vacant posts. The additional national NHSE constraints on
the utilisation of agency staff to cover the shortfall have exacerbated the difficulty of
recruiting adequate numbers of appropriately trained staff. As we begin to redesign
the system we will be addressing this area of concern. We will also be working in
partnership with Health Education England to identify how we address gaps and
utilising different work force schemes such as the children’s wellbeing practitioners
(CWP) and recruit to train (RTT). Our future plans are set out in our workforce section
on page 52. 8 Data provided by CNWL and WLMHT
Waiting Times: Specialist/Urgent Care Services In CAMHS
CNWL WLMHT
Central London
West London
H’don Brent H’w H&F Ealing H’slow Average NWL
Number of CYP on Specialist CAMHS waiting list
2014/15 159 153 200 472 120 44 39 115 1302
2016/17 78 208 154 122 53 31 107 170 923
21
Table 14: Referral Rates 2014/15 and 2016/17
8
Although the number of first attendances has decreased by 7%, the number of follow
up attendances has risen by 16% since the transformation programme began. As
highlighted in Table 15 in NW London we have exceeded the planned 28% increase
in CYP accessing NHS Funded services achieving a 31% increase in 2016/17.
Referrals
CNWL WLMHT
Central London
West London
H’don Brent Harrow H&F Ealing H’slow Total NWL
Referrals made
2014/15 579 975 1114 1548 936 897 1741 1213 9003
2016/17 587
(↑ 0.1%)
1096 (↑ 12%)
1289 (↑ 16%)
1657 (↑0.7)
1079 (↑ 15%)
1035 (↑ 15%)
2093 (↑ 20%)
1596 (↑ 31%)
10432 (↑16%)
Referrals accepted
2014/15 467 808 785 1137 784 748 1533 856 7118
2016/17 416
(↓11%)
792 (↓2%)
828 (↓5%)
766 (↓32%)
627 (↓18%)
922 (↑ 19%)
1638 (↑ 7%)
1108 (↑ 29%)
7097 (↓0.2%)
Referrals per 10,000 children
2014/15 211 243 159 211 164 266 216 196 1666
2016/17 209
(↓1%) 274
(↑ 13%) 184
(↑ 13%) 224
(↑ 6%) 193
(↑ 18%) 307
(↑ 15%) 260
(↑ 20%) 258
(↑ 31%) 1909 (↑ 14%)
First Attendances
2014/15 606 850 689 1280 1207 662 824 627 6745
2016/17 654
(↑ 8%) 769
(↓9%) 847
(↑ 22%) 1139
(↓11%) 1038
(↓14%) 515
(↓22%) 613
(↓26%) 670
(↑ 7%) 6245 (↓7%)
Follow Up Attendances
2014/15 4118 6052 4546 5066 4309 5156 7181 6088 42,516
2016/17 4596
(↑ 11%) 6741
(↑ 11%) 5610
(↑ 23%) 6899
(↑ 36%) 6136
(↑ 42%) 4852 (↓6%)
7238 (↓0.8%)
7478 (↑ 23%)
49,550(↑ 16%)
Total Attendances
2014/15 4724 6902 5235 6346 5516 5818 8005 6715 49,261
2016/17 5250
(↑ 11%) 7756
(↑ 12%) 6457
(↑ 23%) 8038
(↑ 27%) 7174
(↑ 30%) 5367 (↓8%)
7851 (↓2%)
8148 (↑ 21%)
56,041(↑ 14%)
First Attendances per 10,000 children
2014/15 221 212 99 175 211 196 102 101 1317
2016/17 234
(↑ 6%) 192
(↓9%) 121
(↑ 22%) 154
(↓12%) 182
(↓14%) 153
(↓22%) 76
(↑ 25%) 108
(↑ 7%) 1220 (↓7%)
Follow Up Attendances per 10,000 children
2014/15 1499 1506 651 691 753 1530 892 983 8505
2016/17 1641 (↑ 9%)
1503 (↓ 0.2%)
801 (↑ 23%)
986 (↑ 43%)
1076 (↑ 43%)
1440 (↓6%)
899 (↑
0.8%)
1267 (↑ 29%)
9613 (↑ 13%)
Total Attendances per 10,000 children
2014/15 1719 1718 1726 994 1084 749 865 964 9819
2016/17 1875 (↑ 9%)
1939 (↑ 9%)
1922 (↑ 10%)
1086 (↑ 9%)
1410 (↑ 33%)
1593 (↑ 112%)
975 (↑ 13%)
1315 (↑ 33%)
12,115 (↑ 23%)
22
Table 15: NHSE Defined and Actual numbers of CYP Treated by an NHSE Funded
Service8
Expected percentage of CYP treated
2016/17 Actual 2017/18 2018/19 2019/20 2020/21
Borough Estimated
prevalence
(2014)
28% 31% 30% 32% 34% 34%
Brent 4572 1280 1158
1372 1463 1554 1554
Ealing 4692 1314 1197
1408 1501 1595 1595
H&F 1828 512 867
548 585 622 622
Harrow 3171 888 940
951 1015 1078 1078
Hillingdon 4051 1134 1421
1215 1296 1377 1377
Hounslow 3468 971 875
1040 1110 1179 1179
K&C 1440 403 675
432 461 489.6 490
Westminster 2417 677 818
725 773 822 822
Next Steps
2017/18
Redesigning our system to ensure we have a flexible responsive workforce
which meets the needs of our local population.
Developing our workforce to ensure we have the right staff with the right skills
to offer timely access and treatment.
2018/19
Implementing new ways of working to build long term sustainable
improvements to waiting times.
8 Data provided by CNWL and WLMHT
23
5.2 Priority Two: Community Eating Disorders (ED) Service
5.2.1 Funding
2015/16 2016/17 2017/18
Central £91,557 £91,557 £101,000
West £116,621 £116,621 £123,000
H&F £100,744 £100,744 £106,000
Ealing £211,543 £211,543 £212,000
Hounslow £152,983 £152,983 £147,000
Hillingdon £149,760 £149,760 £154,000
Harrow £121,785 £121,785 £128,000
Brent £163,584 £163,584 £180,000
5.2.2 Road Map
5.2.3 Our Ambition
Prior to the initiation of the transformation programme, there was limited access to
community services for CYP with eating disorders across NW London with no specific
community eating disorder teams in place. CYP with suspected or diagnosed eating
disorder were often assessed by local CAMHS teams. Provision and access to
specialist care was inequitable and geographically hard to access from some areas of
NW London. By implementing a new ED service, we aimed to:
Provide rapid access to evidence based care and treatment to CYP with
anorexia nervosa, bulimia nervosa, binge eating disorder, atypical anorexic
and bulimic eating disorder;
Deliver the right intervention at the right time with the best outcomes
Facilitate a shorter recovery period;
Provide local treatment based on individual need, focused on experience and
with the right escalation mechanisms for those CYP who require more
intensive intervention;
Ensure a safe and seamless transition from CAMHS to adult services for
those aged 18 and over;
24
Design consistent services which meet national standards and deliver the best
possible outcomes for CYP;
Enable CYP to access a range of NICE concordant treatment options with
additional support provided for parents and carers;
Deliver streamlined and equitable access for CYP across NW London
together with easy to navigate referral systems and processes for those who
wish to refer into the service.
The anticipated benefits of implementing the programme:
5.2.4 Our Progress
In March 2016 WLMHT and CNWL each developed and implemented a pilot ED
service. Each service was under pinned by the 2015 national specification for ED
services. Services are delivered Monday to Friday 9am to 5pm with additional
support provided by the out of hours’ teams based in a number of Accident and
Emergency (A&E) departments across NW London.
Service Provision
A rapid single point of low-threshold access to community eating disorder
service;
Accessibility - within waiting time guidance (24 hours for emergency, 1 week
for urgent and 4 weeks for routine);
Comprehensive assessment and care planning for people with suspected /
confirmed eating disorders;
Evidence-based treatments for people with anorexia nervosa, bulimia nervosa
and binge eating disorder who can be treated safely and effectively close to
home and without recourse to the specialist multidisciplinary team;
Advice, information and sign-posting to people with eating problems who do
not wish to access treatment services (or who are not eligible for treatment
under the current funding arrangements);
Specialist consultancy to GPs whether or not the service is able tooffer
treatment;
Seamless onward referral to treatment services for people whose needs
cannot be met within a community-based service (e.g. those at higher risk or
requiring multi-disciplinary treatment and care);
A service compliant with NICE Guidance (CG9). The service liaises effectively
with other providers and partners to ensure joined-up care;
Family interventions as a core component of evidence based treatment
required for eating disorders in children and young people;
95% of CYP with an eating disorder will receive treatment between 24 hours
and 4 weeks depending on the urgency of the referral in line with national
access and waiting time standards
Reduction in referrals, transfer to adult services, waiting times and inpatient
admissions.
Develop a highly skilled and multi-agency workforce.
25
Cognitive behavioural therapy (CBT) and enhanced CBT (CBT-E) for the
treatment of anorexia nervosa, bulimia nervosa and related adolescent
presentations.
Reporting and Quality Metrics
A comprehensive dashboard is in place to ensure the ED Service achieves expected
outcomes. Data is captured and reported on a monthly and quarterly basis. Data
captured includes:
Quarterly reporting on number of CYP referred into and out of the service via
a junior Management of Really Sick Patients with Anorexia Nervosa
(MARSIPAN) agreement.
Compliance with the specified Access and Waiting Time Standard for CYP ED
services.
Long-term follow-up data. (provided by Patient Reported Outcome Measures
(PROMS) and clinician-rated outcome measures.
Information about the attitudes and experiences of the child or young person
and family towards the treatments and service being provided (provided by
PREMs).
Care pathway, clinical practice and service development, design and usage
information, including clock starts and stops, referral pathways, and specific
information about the treatment provided and appointments attended.
Evaluation
Evaluation of the Eating Disorder Service took place in April 2017 following a year of
implementation. Since the service commenced over 214 CYP from NW London have
accessed the service. A formal CCG evaluation report is in development which will
include an action plan to address any issues identified. A workshop with key
stakeholders has been arranged for the 1st of December 2017 to discuss the
evaluation and develop a joint quality improvement service plan.
As well as formal evaluation, the service was reviewed by Rethink Young Champions
in three boroughs (Hammersmith and Fulham, West London and Central London.
The report is in development and expected to be formally shared by the end of
November 2017.
Staffing
The specialist community eating disorder service is integrated into CAMHS in
WLMHT and CNWL and provides assessment and treatment for children and young
people with eating disorders. The Trusts’ current activity and staffing levels are
outlined below.
26
Table 16: Staffing of Eating Disorder Services8
Activity Referrals into the new service have significantly exceeded the expectation of 100
referrals suggested in our 2016 plan. Over double (214) the anticipated number of
referrals was received. In addition to referrals from NW London, both of our providers
have assessed and treated CYP from neighbouring London boroughs as well as
other regions in England.
Prior to the ED service being established, WLMHT were unable to identify the
number of CYP with an eating disorder referred for assessment due to the way data
was captured. For those CCG’s who have ED service provided by CNWL, the
number of CYP with an eating disorder referred increased by 53% between 2014/15
and 2016/17 (Table 16).
Table 17: Access to Eating Disorder Services from 20148
Waiting Times
Waiting times performance are submitted monthly to commissioners and are in line
with national and local targets for seeing urgent referrals (one week) and routine (four
weeks). Waiting times are also submitted nationally on Unify to NHS England.
Overall, 80% of the waiting time targets have been met for both routine and urgent
appointments in 2016/17. The expectation is 100% of urgent EDS appointments will
be see within 1 week. Exception reporting is in place for instances where this is not
the case. 95% of routine appointments are expected to be seen within four weeks.
8 Data provided by CNWL and WLMHT
West London Mental Health Trust Central and North West London NHS Trust
Consultant Psychiatrist
0.7 WTE Consultant Psychiatrist 0.1WTE
Speciality Doctor (SPR)
1WTE Paediatrician 0.2WTE
Systemic Family Psychotherapy
1xband 8B 0.6WTE, 2.2xband 8A WTE
Systemic Family Psychotherapy
1xBand 8A WTE, 1xBand 7 WTE
Clinical Psychology
1x band 8A WTE Clinical Psychology 1x Band 8B WTE, 0.6 x Band 7 WTE
Nursing 1xband 7 WTE, 1x band 6 WTE
Nursing 0.9x Band 7 WTE, 1x Band 6 WTE
Dietitian 0.3 x band 6 WTE Dietitian 0.5x Band 6 WTE
Administration 1x band 4 WTE Administration 1x Band 4 WTE
Assistant Psychologist 1x Band 4 WTE
Referrals Accepted 16/17
Eating Disorders Referrals Accepted
Central London
West London
H’don Brent H’w H&F Ealing H’slow
TOTAL NWL
2014/2015 17 CNWL
8 CNWL 18
CNWL 8
CNWL 12
CNWL N/A N/A N/A
2015/2016 7 CNWL
16 CNWL
8 CNWL
7 CNWL
11 CNWL
N/A N/A N/A
2016/17 23
CNWL 20
CNWL 27
CNWL 23
CNWL 24
CNWL
25 (19 WLMHT
and 6 CNWL)
46 (41 WLMHT
and 5 CNWL)
26 (WLMHT)
214
27
Table 18: Access to Eating Disorder Services8
Table 19 highlights several breaches occurred, notably in Hounslow and Brent. It is
important to note that numbers of CYP referred to the EDS are often small, especially
for emergency appointments, therefore 1 breach can have a significant impact on the
compliance data. Urgent appointment breaches have decreased significantly in the
first 5 months of 2017/18 with 96% of waiting time targets met.
Routine breached are monitored at the monthly meetings between commissioners
and providers in each borough with action plans implemented where performance
does not meet specified targets.
Table 19: Compliance to National Waiting Times
8
Hounslow’s data breaches were attributed to internal WLMHT data recording issues
experienced as the new service was being implemented. Issues are now rectified and
processes put in place to prevent further data recording issues arising.
The Quality Network for Community Eating Disorder services
The Quality Network for Community Eating Disorder services for children and young
people (QNCC-ED) is a network that aims to improve services for children and young
people through a supportive, standards-based review process. The network was
developed following the commissioning guide published by NHS England which
focused on improving access and implementing national waiting time standards for
children and young people with an eating disorder.
8 Data provided by CNWL and WLMHT
Referrals 16/17
CNWL WLMHT
Central London
West London
H’don Brent Harrow H&F Ealing H’slow TOTAL NWL
Routine (4 weeks) 17 14 22 17 19 18 35 22 164
Urgent (1 Week) 6 6 6 6 5 1 6 4 40
Emergency (24hrs) 0 0 0 0 0 0 0 0 0
Total NW London 185
% Compliance to National Waiting Times (%)
CNWL WLMHT
Central London
West London
H’don Brent Harrow H&F Ealing H’slow TOTAL NWL
Routine (4 weeks) 88% 79% 77% 88% 79% 88% 89% 59% 81%
Urgent (1 Week) 100% 100% 80% 67% 80% 100% 83% 25% 80%
Emergency (24hrs) - - - - - - - -
28
The QNCC-ED standards provide the basis for the annual review process and are
used by member services to benchmark themselves nationally against peers. Both
WLMHT and CNWL have registered with the network. CNWL have had their peer
review and are awaiting the outcome. WLMHT are in the process of working towards
accreditation and are awaiting their peer review.
Feedback from some of our young people who have used the service.
5.1.5 Next Steps
2017/18
Evaluation, review and refinement. Developing a joint quality improvement
action plan looking to enhance service provision including self-referral, 7 days
and after hour clinics and home visits.
Streamlining the referral process, especially for GP’s in some areas
Defining a robust communication plan to ensure CYP, parents and carers and
other key referrers (i.e. GPs) are aware of any agreed changes.
Ensuring both CNWL and WLMHT are compliant to The Quality Network for
Community Eating Disorder services for children and young people (QNCC-
ED) standards and have been formally reviewed.
2018/19
Key decisions regarding testing the market to be made.
Business as usual monitoring
North West London Eating
Disorder Service
They pay attention to what you say
Very easily accessible with self-referral system, no delays. Frequent appointments tailored to need, reducing and increasing frequency depending on level of input required. Able to talk to our therapist on phone when need extra help. Everyone we have dealt with has been caring and professional.
Everyone is so supportive and you feel really safe. You can come here with anything as it is a non-judgmental service. You are reassured that you're not the only person going through this.
I feel more listened to and heard than previous places
29
65.3 Priority Three: Redesigning the System
5.3.1 Funding
2015/16 2016/17 2017/18
Central £60,000 £207,045 £91,630
West £88,000 £244,509 £90,000
H&F £56,000 £189,026 £80,000
Ealing £206,700 £328,765 £290,960
Hounslow £127,930 £246,902 £142,056
Hillingdon £120,000 £140,000 £140,000
Harrow £170,000 £270,000 £270,000
Brent £154,468 £166,000 £112,000
5.3.2 Road Map
5.3.3 The Ambition
We have high aspirations for children and young people’s emotional wellbeing and
mental health provision in NW London. Our ambition is to provide high quality,
equitable intervention which achieves the same outcomes no matter where in in the
system help is accessed. We believe that fundamental for success is: -
1. Children, young people, their families and carers are at the heart of
developing NW London services;
2. Every child and young person in NW London has access to local help and
support that promotes emotional wellbeing and builds resilience;
3. When mental health issues do arise, early help and intervention in schools
and local communities can be easily accessed, building confidence and
supporting self-management;
4. We have an easy to navigate system in place delivered by joined up services
which are multi-agency;
5. Flexible intervention and support offered is sensitive to individual needs and
reflects the wishes and preferences of the child, young person as well as their
families and carers.
30
6. There is a holistic approach to intervention enabling children and young
people to access appropriate support no matter where in the system they
access care;
7. Children and young people can access intervention which reflects their
changing needs and supports them transition into adult services;
8. Children and young people who require health based care have timely access
to evidence based intervention with clear outcomes and treatment goals;
9. Support options are available for children and young people with complex
needs but for whom health based interventions are not suitable;
10. We have a flexible and adaptable workforce with the right skills to deliver high
quality, sustainable services;
11. Our aims and objectives are progressive and adapted to meet changing local
needs such as the Grenfell Fire national disaster and align to other evolving
national and local directives and programmes such as NHSE specification,
Transforming Care Programme (TCP), New Models of Care (NMoC) and
Thrive London the Mayor’s city wide mental health programme.
The anticipated benefits of implementing the programme:
Better health and wellbeing for our children and young people
Improvements in physical, mental, social, emotional and educational
wellbeing, leading to improved quality of life and resilience;
Children and young people receive holistic, proactive and well-coordinated
support in the least intensive setting;
A wide variety of help and intervention is available, tailored to the needs,
wishes and preferences of the individual child or young person.
Transformed quality of care delivery
Professionals are supported to deliver effective coordinated care across
organisational boundaries;
There is an ethos of continuous improvement and responsiveness to the
changing needs of the population;
Clarity of process and support structures enables staff to feel more confident
in carrying out timely and supported transfers and transitions;
Clarity on roles and responsibilities leading to effective joint shared
responsibility for the welfare of children and young people;
There are clear pathways in place to support seamless transition to adult
services.
Sustainability of Services
The most effective use of available resources delivering sustainable services;
Unnecessary hospital admissions are avoided;
Correct balance of resource and skills across all settings of care;
Integrated care through multi-disciplinary teams with skills and disciplines to
deliver flexible, more responsive and more creative treatment;
Organisational clarity on strategic aims and purpose: joint shared
responsibility for the welfare of children and young people.
31
5.3.4 Our Progress
A primary concern amongst many CYP, their families and carers as well as and
professionals who are trying to provide help and support is navigating a fragmented
complex system with no clarity on what help is available and how that help can be
accessed. Although numerous local initiatives have been implemented in each
borough that provide early intervention, expand access and improve the quality of the
support and treatment offered, a systematic approach has not been undertaken. To
help us identify gaps and help us focus our resources, the AFC carried out a needs
assessment which identified several gaps. The gaps are set out in Table 19 below
Each Local Authority publishes a local offer on their website which highlights both
health and non-health based services available locally. Details of each local offer are
outlined in each annex.
Table 20: Gaps Identified by AFC Needs Assessment
Resilience and Self-Management
No strategic coordination of prevention & promotion resources available at borough, NW London and pan-London level making help and support difficult to navigate.
Early Intervention, support and sign posting
An uncoordinated approach to offering advice and support;
No central information point;
Lack of dissemination to professionals (health, education, social care, third sector), young people, parents and carer on where they can access general help and support;
Lack of digital interventions to support self-management and build resilience.
Specialist Evidence based Treatment
Lack of interagency coordination and integration;
Siloed approach to CAMHS provision;
High treatment thresholds that are barriers to obtaining support;
Long waiting times with limited interim support solutions offered;
No step-up step-down approach in the community;
Inflexible traditional model of care offered;
Lack of early intervention for Learning Disabilities (LD) and Neurological Disorders (ND).
Interagency support and Intervention
No consistent approach to targeting vulnerable groups not who are not engaged;
No joint agency working or joint plans developed.
In addition to clarifying local need in terms of emotional wellbeing and mental health,
new approach and ways of working were recommended. Central to this concept was
the adoption of THRIVE as a mechanism to supporting implementation in NW
London.
9
THRIVE Elaborated. Wolpert et al 2016
http://www.annafreud.org/service-improvement/service-improvement-resources/thrive/1
32
THRIVE conceptual Framework
THRIVE is a needs based, person centred, conceptual framework which promotes a
whole systems approach to address crucial issues outlined in Future in Mind2 as well
as aligning to emerging work on payment systems, quality improvement and
performance management. The framework places emphasis on prevention and early
intervention and is currently being tested and evaluated through a national
implementation programme i-THRIVE10.
THRIVE is based on 5 needs based groupings and aligns to existing initiatives such
as Choice and Partnership Approach (CAPA) and Children and Young People
Improving Access to Psychological Therapies (CYP IAPT). The 5 needs based
groupings are: -
Thriving: Focus on community based initiatives concentrating on prevention
and promotion of emotional wellbeing.
Getting Advice: Building resilience to support communities (school and
family) to prevent, support and intervene in mental health issues.
Getting Help: Focuses on health based interventions with clear treatment
goals and set criteria to assess whether those aims had been achieved.
Getting More Help: Emphasis on intensive and extensive longer-term health
based treatment.
Risk Support: Often resource intensive and requiring considerable input, this
group focuses on those children and young people for whom traditional health
based care does not currently meet their needs.
2 Future in Mind DoH/NHSE 2015 https://www.gov.uk/government/uploads /system/ uploads/
attachment data/file/414024/Childrens_Mental_Health.pdf 10
i-THRIVE https://www.implementingthrive.org
33
NWL Collaboration has agreed to adopt and adapt THRIVE model to provide the
basis for its system redesign programme. Our emerging model is based on four core
values: -
1. Building on Local Quality
A review of the individual needs assessments carried out in each locality identified a
significant number of high quality initiatives already in place. However, many of these
initiatives are implemented locally and not widely shared across NW London. To
promote dissemination and shared learning we will implement mechanisms to ensure
the approach and impact of innovation is captured and shared.
2. Addressing Gaps
The local needs assessments (both AFC and JSNA) identified several gaps which will
need to be addressed in the NW London Model. Gaps are outlined in Table 20 on
page 31.
3. Aligning to Existing Programmes
This whole systems model will not be developed in isolation and will align to other
transformation programmes (Social Care, Paediatrics, Adult Mental Health Services,
and Transforming Care Partnership, New Models of Care) to ensure children and
young people who require emotional support receive seamless care wherever they
access help.
4. Incorporating Key Principles of the THRIVE Model
To deliver the changes required to ensure THRIVE underpins the NW London Model
several changes to existing practice and the implementation of new ways of working
are required.
Developing our NW London Model of Care
To help us define local priorities and engage stakeholders from across the system we
held an initial launch event in July 2017 focused on early intervention and prevention.
A wide range of representatives (Young people, parents as well as representatives
from social care, public health, education, commissioning, the police attended The
outputs from this event together with the AFC recommendations and local data have
enabled us to put together the outline of a service delivery model which is shown on
page 34.
As we have moved forward with our complex, multidimensional redesign programme
the challenge of delivering all the elements of our chosen quality improvement
framework (THRIVE) across 8 CCG’s, 8 local authorities, and 743 educational
establishments has become clear. We have agreed our initial focus on early
intervention and prevention works best when delivered at borough level where local
relationships can be built and community needs met.
We have adopted a modular approach to implementation with each borough setting
out their local vision in each annex together with the work programmes implemented
to meet their local ambition. As we progress we will be developing our joint work plan
to collaboratively redesign applicable components of our system.
34
Measuring for Success
Measuring how effective we are at providing intervention and treatment is crucial to
evaluate the success of our transformation programme and is a fundamental principle
of Future in Mind1 and The Five Year Forward View for Mental Health11. Transparent
reporting and measurement highlights variations quality and cost and provides a
basis for service improvement.
As we implement new service delivery models we aim to build a culture of continuous
improvement, identifying what we can do better, learning from it and acting on it.
Although there are some mechanisms in place through business as usual routes to
review data, to date we have not had a systematic approach to capture and monitor
data across NW London. As well as enabling us to assess the effectiveness of our
intervention, support service planning, commissioning and benchmarking, robust
reporting and monitoring mechanisms will support CCG, Strategy and Transformation
and NHSE reporting requirements. To support the NW London children and young
people’s emotional wellbeing and mental health transformation programme a system
wide approach to data capture is essential.
2 Future in Mind DoH/NHSE 2015 https://www.gov.uk/government/uploads/ system/
uploads/attachment data/file/414024/Childrens_Mental_Health.pdf. 1 Five Year Forward View Mental Health https://www.england.nhs.uk/wp-content/uploads
/2016/02/Mental-Health-Taskforce-FYFV-final.pdf.
35
Aligned to our new service delivery model, a series of indicators will be defined to
measure our achievement against our planned priorities. Using these and other key
indicators and outcomes, a dashboard will be developed. The planned dashboard will
be aligned to four of the five THRIVE needs based groupings which under pin our
new service delivery model:
Early Intervention support and signposting (Getting Advice)
Specialist evidence based treatment (Getting Help)
Intensive and extensive longer-term treatment (Getting more Help)
Inter-agency support and intervention (Risk Support)
The dashboard will also incorporate reporting requirements for the national Mental
Health CAMHS Quality Dashboard, the London Mental Health Executive Dashboard,
The Mental Health Services Data Set and other data requirements from NHSE. The
dashboard will be adapted as new reporting stipulations are made and will align and
evolve to meet national specifications. The dashboard will be the main mechanism for
assessing progress against our defined trajectories and will measure the success of
the NW London transformation plan.
Communications Plan
Although we have implemented robust communications plans for all our new services
and each CCG has implemented local plans to highlight new local services, an
overarching plan has not been developed. In 207/18 we will be working with our
communication teams in both the STP and individual CCG’s to develop a robust
overarching plan.
5.3.5 Our Next Steps
2017/18
Define the elements of the programme on which we will work together across
NW London and which elements we will deliver at local level.
Develop a clear road map, define timescales and widen stake holder
engagement.
Align the programme to local and national initiatives such as the transforming
care programme, New Models of care, Forensic CAMHS Service for London
and Tier 4 inpatient reconfiguration.
Develop a communication strategy
Develop an outcome dashboard and redesign the data capture and
monitoring processes through which we will measure our success.
2018/19
Implement new ways of working and new service delivery models
Make key decisions regarding testing the market and commissioning third
sector providers to deliver elements of the programme.
2019/20
Evaluation and Business as usual and or procurement and mobilisation based
on 2018/19 decisions.
36
5.4 Priority Four: Vulnerable Groups
5.4.1 Funding
2015/16 2016/17 2017/18
Central £52,000 £60,778 £185,000
West £30,000 £85,000 £143,000
H&F £79,174 £99,160 £81,500
Ealing £91,729 £64,916 £170,218
Hounslow £91,000 £61,028 £61,028
Hillingdon £100,000 £100,000 £155,000
Harrow £54,840 £20,000 £56,000
Brent £96,000 £63,550 £63,550
5.4.2 Road Map
5.4.3 The Ambition
Our previous plans in 2015 and 2016 focused mainly on Neurodevelopmental
Disorders and Learning Disabilities as part of our plan to improve services to
vulnerable groups. As our local programmes have progressed, and the national
programme targeting vulnerable groups has evolved, we have realised our focus is
too limited. We have therefore widened the scope of this priority to include other
vulnerable groups such as those who are involved in the youth justice system and
looked after children.
Learning Disabilities (LD) and Neurodevelopmental Disorder (ND)
LD and conditions grouped under ND i.e. Autistic Spectrum Disorder (ASD), Conduct
Disorder, Attention Deficient Hyperactivity Disorder (ADHD), communication
disorders, motor disorders and specific learning disorders are often discussed as one
single entity when they are in fact several very distinct conditions with different
assessment, treatment and support pathways. At present the care offered to children
and young people with LD and ND is highly variable across NW London, we have
decided to focus on specific conditions separately, grouping together where
appropriate but developing individual work programmes.
37
Despite having a number of widely recognised best practice initiatives in place across
NW London, several issues are widely recognised for all related conditions: -
Variation in accessing services with waiting times of over 6 months in some
boroughs for ASD;
Differences between waiting times for 0-5years and 5+years;
Variation in service provision with inequitable support services offered across
NW London (i.e. Occupational Therapy, Speech and Language Therapy
Family Support);
Vastly different commissioned and resourced services with variable service
delivery models and pathways in place;
Different frameworks in place with each local authority;
Fragmented services with disjointed pathways into paediatrics;
Location of services and environment in which care is delivered not always set
up for CYP with special needs;
Accident and Emergency care frequently challenging with no suitable quiet
spaces available;
Knowledge of non-specialist staff on supporting CYP and their families often
poor;
The significant cost of current LD/ND services to health, social care and
education providers and commissioners;
Families facing difficulties in navigating the system and lack of meaningful
advice and information to support families to meet needs of children and
young people awaiting assessment;
Transition into adult services can often be poorly managed.
The anticipated benefits of implementing the programmes:
A reduction in waiting times with children, young people their families and
carers able to access timely assessment and treatment;
Coordinated pathways across paediatrics, social care, education, criminal
justice and mental health services provide seamless assessment, intervention
and shared plans;
Clear working practices established between CAMHS services and special
educational needs (SEN) departments, to support coordinated assessment
and planning of education, health and care (EHC);
Integrated care through multi-disciplinary teams with skills and disciplines to
deliver flexible, more responsive and more creative treatment;
A wide variety of help and intervention is available, tailored to the needs,
wishes and preferences of the individual child or young person;
Parents, carers and professionals have the right skills to manage challenging
behaviour with behavioural support training is widely available;
Children at risk of placement breakdown, offending or admission are
monitored and have robust management and risk plans in place;
Alignment to the adult Transforming Care Programme to ensure there is
seamless transition between child and adult services;
Unnecessary inpatient admissions are avoided.
38
5.4.4 Our Progress
In 2015/16 the current services and interdependencies were mapped out in detail.
Several workshops were arranged including workshops with CNWL, CCG’s and
WLMHT. As part of the needs assessment the AFC also conducted a series of
workshops. All the workshops were multi agency and co-produced.
The original aim was to create uniform standards across the eight boroughs however;
this has been deemed challenging as each borough had different infrastructure,
pathways and services. In our 2016 plan, we outlined three areas where there was
broad agreement to work together: -
Access to assessment and treatment.
Improving health and educational outcomes.
Experience of care Each CCG has identified and established work plans to transform services and
improve waiting times at local level. Establishing a clear work plan for the agreed
areas across all 8 CCG’s has again proved challenging. To address this, we have
refocused our programme and are in the process of clearly establishing what areas
will be taken forward collectively and what elements of the programme will be carried
out locally. Our initial plan is to focus on ASD primary together with some elements of
LD aligned to the Transforming Care Programme (TCP).
Transforming Care Programme (TCP)
The national TCP programme aims to radically improve the services aimed at people
with autism and learning disabilities. This is an all age programme and we are
working in partnership with the STP TCP team to ensure our transformation
ambitions are delivered. Responsibility for delivering elements of the TCP related to
CYP sit within the CYP programme. Three key pieces of work related have been
delivered:
Positive Behavioural Support Training (PBS)
The NW London PBS training programme is part of a wider workforce development
programme that includes a person-centred support e-learning programme for paid
staff and family members together with awareness training for staff working in
frontline crisis services such as A&E. A range of comprehensive training programmes
which embed the values and practice of Positive Behavioural Support are being
delivered across NW London. The overall programme consists of distinct training
courses and includes a train the trainer model for sustainability. Programmes offered:
Foundation training for family carers
PBS training for social care support staff
Enhanced PBS train the trainer for social care staff
Local PBS lead for social care providers
39
The anticipated outcomes
- People with learning disabilities and behaviours that challenge will benefit
from high-quality, evidence-based support delivered by competent
professionals working as part of a multi-disciplinary team.
- Practitioners will benefit from professional development and occupational
standards.
- Organisations supporting individuals with intellectual disabilities and
behaviours that challenge will be able to employ practitioners with a greater
degree of certainty about competence and quality.
- Commissioners will have a greater understanding of the nature and use of
PBS in practice.
- Parents and carers will have the enhanced skill to manage challenging
behaviour at home and will have a clear understanding of PBS plans.
Improving Outcomes for Learning Disabilities and Autism Patients in Emergency
Care
To improve access for people with LD and ASD to emergency care in NW London
and improve outcomes a comprehensive training programme focused on emergency
staff is in place. Delivered across six NW London secondary care providers: Imperial
College Healthcare NHS Trust, Chelsea and Westminster NHS Foundation Trust,
London North West Healthcare NHS Trust, Hillingdon Hospitals NHS Foundation
Trust, Royal Marsden NHS Foundation Trust, Royal Brompton and Harefield NHS
Foundation Trust, the programme supports staff to be competent and confident
working with people with LD or ASD. A range of staff have been offered training
including:
A&E staff and other hospital staff
London Ambulance Staff
Staff from the single points of access (SPA) from our two mental health
Providers CNWL and WLMHT
The anticipated outcomes
- Better experiences for people with LD or ASD and their carers when they
come into hospital, resulting in successful investigations, treatment and care.
- Improved staff competencies in supporting and caring for CYP and adults with
LD and/ or ASD.
- Improved understanding of the value of a life lived with a learning disability or
autism, underpinned by a flexible approach that ensures person centred
treatment is as the heart of all aspects of care.
NW London CYP Dynamic Register
A dynamic register is the national service model used to describe a dynamic process
for risk stratification of the local population of people with a learning disability, autism
or both who display behaviour that challenges. Those likely to be included are:
- CYP at risk of family or placement breakdown.
- CYP with a 52-week placement
- CYP who are a risk to themselves and others
- CYP at risk of coming into contact with the criminal justice system
- CYP at risk of admission
40
The register aims to support contingency planning, enable care coordination, promote
risk management and ensure seamless transition between adult and children’s
services by acting as a trigger for forward planning and anticipating issues. In NW
London, we have begun the process of developing and implementing registers for
both CYP and adults. Harrow CCG are leading the process for CYP.
Access to Assessment and Treatment for CYP with a Learning Disability or
Neurodevelopmental Disorder
Learning Disability
Table 21: Learning Disability Referrals
Table 22: Learning Disability Contacts
Between 2014/15 and 2016/17 Learning disability referrals increased across NW
London by 66% (Table 19), with contacts increasing by 52% (Table 20). Contacts are
forecast to increase further 3% in 2017/18.
8 Data provided by CNWL and WLMHT
Neurodevelopmental Disorders
Learning Disability Referrals
CNWL WLMHT
Central London
West London
H’don Brent Harrow H&F Ealing H’slow TOTAL NWL
2014/15 11 13 18 49 37 6 73 43 250
2015/16 10 12 29 33 41 14 60 41 240
2016/17 10 42 39 48 64 7 115 53 378
2017/18 (Forecast) 7 46 36 41 38 7 106 34 315
Learning Disability Contacts
CNWL WLMHT
Central London
West London
H’don Brent Harrow
H&F Ealing H’slow
TOTAL NWL
2014/15 390 145 706 284 212 152 740 127 2756
2015/16 425 259 807 390 187 248 675 253 3244
2016/17 580 112 1369 908 773 194 1012 311 5259
2017/18 (Forecast)
715 178 1406 1032 691 120 979 283 5404
41
Table 23: Neurodevelopmental Waiting Times
The number of ND referrals has increased significantly between 2015/16 and
2016/17 (45%).Table 23 highlights our waiting list numbers. Although the number of
young people on the waiting list has increased by 54%, the time they are waiting has
decreased (11%). This is not across the whole of NW London with West London
Hillingdon, Harrow and Brent seeing increases in the time from referral to treatment.
Table 24: Neurodevelopmental Referrals
Table 25: Neurodevelopmental Contacts
Increases in the number of CYP on the waiting lists are attributed to a combination of
increasing referrals and capacity issues. Referrals into services vary widely due to
differences in local pathways with some CYP being referred directly into CAMHS
whilst in other areas the pathway is accessed via paediatrics.
8 Data provided by CNWL and WLMHT
ND Waiting Times
CNWL WLMHT
Central London
West London
H’don Brent Harrow H&F Ealing
H’slow
TOTAL NWL
Number CYP on Waiting List
Waiting List June 16
1 9 0 98 0 25 97 222 425
Waiting List June17
11 1 14 48 18 0 305 258 655
Referral to Treatment Time (days)
June 16 77 42 35 49 35 182 365 365
1150
June 17 71 109 53 110 135 98 199 247 1022
ND Referrals
CNWL WLMHT
Central London
West London
H’don Brent Harrow H&F Ealing H’slow TOTAL NWL
2014/15 19 32 39 67 79 26 313 365 940
2015/16 21 29 19 65 49 13 317 330 843
2016/17 31 60 55 107 93 32 429 421 1228
2017/18 (Forecast) 41 71 75 36 107 17 336 398 1081
ND Contacts
CNWL WLMHT
Central London
West London
H’don Brent Harrow H&F Ealing H’slow TOTAL NWL
2014/15 403 323 269 578 862 186 1255 2200 6076
2015/16 516 341 289 666 733 262 1227 2318 6352
2016/17 524 241 555 774 678 366 1382 2797 7317 2017/18 (Forecast) 624 276 590 569 720 307 1092 2402
6580
42
Additional funding has been allocated in some areas to address waiting times and
targeted local approaches are in place. It should be noted historical data quality
issues have been identified in some areas. Improvements have occurred and going
forward we will have a more accurate picture of activity.
Conduct Disorder
Almost 16,000 North West London children are estimated to have severe behavioural
problems (conduct disorder) which impacts negatively on their progress and incurs
costs across the NHS, social services, education and the criminal justice system.
NICE guidance recognises parenting as an effective intervention for children aged
between 3 and 11 years at high risk of conduct disorder, and for ADHD. Mapping of
parenting provision across NW London carried out in 2015 has shown that provision
of parenting support is patchy, often not sustained and poorly evaluated.
We are piloting a health and education integrated approach to the prevention of
conduct disorder and ADHD in children, through early identification, training and
positive parenting support delivered within schools. This forms part of our
commitment, set out in North West London’s Sustainability and Transformation Plan,
to radically upgrade prevention and wellbeing and enable children to get the best
start in life. The pilot, based in Ealing, will be evaluated and if successful will be used
to inform wider delivery across NW London. Key features of success will be
effectiveness (primarily improvement in child behaviour outcomes), sustainability of
delivery and scalability across NW London.
Health and Justice
We are working in partnership with NHSE on the Health and Justice/Specialised
commissioning CYP Mental Health workstream. A key aim of this workstream is to
improve the health and justice outcomes of young people who are in or at risk of
entering the justice system. Across NW London the number first time entrants into the
criminal justice system are higher than the English average.
In 2016 NHSE allocated central funding for the purpose of commissioning liaison and
diversion services and enhancing the health and wellbeing pathway for this group.
The funding could be carried over to 2017/18 but a needs analysis and mapping
exercise conducted in partnership with the Youth Offending teams and other relevant
partners was required to be submitted to NHSE.
Initially we looked to conduct this work across NW London. However, after reflecting
on the complexities this would entail, we decided collectively to undertake this
programme of work in each individual CCG. Local annexes’ set out plans for YP at
risk of offending and reoffending in each locality, ensuring they are integrated into the
wider transformation programme. Each CCG has defined a work programme, setting
out the local ambition, the coproduction processes underpinning the programme, key
deliverables and the process through which progress is monitored.
43
Early Intervention Service (Psychosis)
Across NW London our early psychosis offered is provided in partnership with the
Adult Early Psychosis Teams. CAMHS Services take the lead for those aged 14-18
years with support from the adult teams. There is a standardised process, associated
care protocols and identified transition points in place.
Looked After Children
LAC frequently have multiple and complex needs. To address these needs a multi-
agency approach with education, health and local authorities working in partnership is
recommended. Due to the local nature of these initiatives, services specifically
targeting looked after children are outlined in the individual CCG annexes.
5.4.5 Next Steps
2017/18
Establishing a clear road map for ND and LD and developing a detailed work
plan work plan including clarifying the aspects of the programme delivered at
local level and those aspects delivered across all 8 CCG’s.
Continued alignment with the TCP programme and NHSE best practice with
the introduction dynamic registers for CYP in each CCG.
Continue to expand and define our Health and Justice and LAC programmes
as well as identifying other groups who would benefit from specific
programmes.
Evaluating our processes around transition to adult services to ensure they
are fit for purpose.
Embedding sustainable PBS training across NW London.
2017/18
Implement new ways of working, pathways and service delivery models in line
with national, ST and local plans.
2018/19
Evaluation and market testing of specific services and training programmes.
44
5.5 Priority Five: Crisis and Urgent Care
5.5.1 Funding
2015/16 2016/17 2017/18
Central £0 £40,000 £66,000
West £65,000 £40,000 £130,000
H&F £0 £32,600 £145,000
Ealing £32,000 £237,316 £244,819
Hounslow £34,000 £75,000 £130,976
Hillingdon £100,000 £100,000 £195,000
Harrow £40,000 £14,840 £73,517
Brent £10,000 £108,000 £111,725
5.5.2 Road Map
5.5.3 The Ambition
A crucial component of delivering the right care at the right time is the provision of
accessible, consistent and effective care for CYP in mental health crisis. Several
national strategies and policies: Future in Mind2, the Five Year Forward View for
Mental Health11, Mental Health Crisis Concordat12 and the Healthy London
Partnership’s Mental Health Crisis Care for Children and Young People13, define
expectations of service delivery.
2 Future in Mind DoH/NHSE 2015
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf 11
Five Year Forward View Mental Health https://www.england.nhs.uk/wp-content/uploads /2016/02/Mental-Health-Taskforce-FYFV-final.pdf. 12
Mental Health Crisis Concordat
http://www.crisiscareconcordat.org.uk/ 13
Mental Health Crisis Care for Children and Young People Healthy London Partnership 2016 https://www.myhealth.london.nhs.uk/sites/default/files/Improving%20care%20for%20children%20and%20young%20people%20with%20mental%20health%20crisis%20in%20London.pdf
45
Aligning to other national and local work programmes with interdependencies
including the New Models of Care Programme (NMoC) and TCP, our aim is to
provide easily accessible, integrated 24/7 support and intervention for CYP in crisis.
Our aim is to:
1. Improve access to care: ensuring CYP who live in NW London can access high quality emergency care and support 24/7;
2. Reduce avoidable admission to hospital: preventing inappropriate hospital admissions (paediatrics, adult MHU and Tier 4 CAMHS) and linking children to appropriate intensive community support services;
3. Providing timely care enabling CYP who live in NW London to access timely emergency care and support 24/7 with minimal waiting times;
4. Introducing a step-up step down approach to enable CYP to access the right help at the right time in the right location;
5. Improving experience of CYP by supporting access to needs-based seamless care and signposting to applicable longer-term support and intervention based on their individual wishes and preferences;
6. Provide multi-agency joined up care delivered across organisational boundaries;
7. Align to the London health based places of safety initiative being carried out by the Healthy London Partnership;
8. Ensure all CYP have a safety and coping plan in place.
The anticipated benefits of implementing the programmes:
There will be a reduction in unnecessary hospital admission to CAMHS beds
and the use of adult and paediatric beds will be avoided;
There is a viable alternative to inpatient care;
CYP can access care closer to home;
There will be a coordinated approach across health, justice, social care and
education;
Pathways will align and support successful delivery to the NMoC Programme
in NW London;
The experience of CYP in crisis will improve;
There will be a reduction in A&E attendances.
46
5.5.4 Progress
Out of Hours and Crisis Care
For NW London, the essential first step in developing consistent infrastructure to
deliver integrated 24/7 was the implementation of Out of Hours crisis service. In April
2016 funding was allocated to CNWL and WLMHT to develop and implement an out
of hours’ crisis pilot service across NW London. The pilot aimed to bring parity of
esteem of CYP presenting with mental health issues in Accident and Emergency
Units (A&E’S) during OOH. The services enabled CYP up to the age of 18 in crisis to
be assessed and supported by CAMHS qualified nurses in a timely manner. All CYP
who present in crisis in A&E, urgent Care Centres (UCC), in S136 suites and when
an emergency admission is sought are assessed. In 2016/17 over 800 CYP
accessed the service.
The key aims of the CAMHS OOH service are to:
Enable access to specialist child and adolescent mental health services from
first contact;
Improve the experience for CYP in crisis to ensure the right decisions can be
made regarding initial care and treatment required;
Support access to specialist CAMHS advice for GP’s, Accident & Emergency
staff, paediatricians, police, emergency duty teams, young people and
families;
Provide integrated care with seamless and timely pathways into community
CAMHS;
Provide education and training to a variety of staffing groups;
Provide support to those seeking emergency inpatient care out of hours;
Implement a safety and coping plan.
Table 26: Staffing of THE OOH Service
8
Table 27: Operational Hours
8 Data provided by CNWL and WLMHT
West London Mental Health Trust Central and North West London NHS Trust
Nursing 1x Band 8a 4.29 WTE, 2x7 Band 7 WTE.
Nursing 2xBand 7
West London Mental Health Trust Central and North West London NHS Trust
4:30 to 9am Monday to Friday
24hrs on Saturday
Sunday and Bank Holidays)
4pm to 7am Monday to Friday
24/7 Saturday, Sunday and Bank holidays
47
Table 28: OOH Service 1st
April 2016 to 31st
March 2017
Evaluation
Evaluation of the OOH took place in September 2016 with further evaluation in July
2017. As well as formal evaluation, the service was reviewed by Rethink Young
Champions in three boroughs (Hammersmith and Fulham, West London and Central
London. The report is in development and will be formally shared in November 2017.
878 CYP have accessed the service. The vast majority of cases assessed were for
self-harm, suicidal ideation and overdose. Although the services successfully met the
general aims and were very well received by CYP, their parents and carers, the
evaluation of the OOH service identified several challenges:
Difficulty recruiting staff on this shift pattern leading to over reliance on agency
staff;
Challenges with capacity due to delivering services over a large geographical
area leading to reliance on existing staff such as Psychiatric Liaison Services
to review CYP within contacted timescales;
Fragmented service provision with out of hours not linked to in hour’s crisis
services;
Robust data capture systems were not in place;
Health focussed with limited social care input;
Capacity to support training of A&E staff limited in some areas;
Ability to fully support other colleagues i.e. police, paramedics limited due to
capacity;
Intensive community service focussed on reducing unnecessary admission
not in place in all areas.
To address these challenges additional funding was allocated in April 2017 to provide
a fully integrated 24/7 CYP Crisis Service across NW London. The service will be
delivered by CNWL and WLMHT who are working in partnership to develop
pathways. Although the service delivery model will vary from borough to borough due
to differing local infrastructure, the pathway will be consistent across NW London and
CYP will experience the same high-quality care and outcomes no matter where they
access care.
The 2 year pilot is linked to the New Models of Care Programme (NMoC - outlined on
page 49) and will provide intensive community intervention to prevent unnecessary
hospital admission and facilitate early discharge. Savings from NMoC will be also be
invested in crisis and community services. The service is expected to go live in late
2017. Pathway development and recruitment is underway.
Central London
West London
H’don Brent H’w H&F Ealing H’slow TOTAL NWL
Assessments 40 80 123 117 102
84 ( 4
WLMHT 80
CNWL)
170 (91
WLMHT and 79 CNWL)
162 (WLMHT 158 and 4 CNWL) 878
48
The new service will be a stepping stone to our longer term vision for a fully
integrated crisis and home treatment team. Developing this service is a crucial
component of redesigning the system.
Feedback from some of our young people who have used the service.
5.4.5 Our Next Steps
2017/18
Fully mobilise the new pilot 24/7 Crisis Service
Plan for future developments including integrated multi-agency intensive
community services
Complete OOH Evaluation
Develop a dashboard with key outcomes to be monitored.
2018/19
Make key decisions regarding testing the market and commissioning third
sector providers to deliver elements of the programme.
Evaluation
2019/20
Business as usual and or procurement and mobilisation based on 2018/19
decisions.
Thanks I needed help now I can go home
North West London Out of Hours Crisis
Service
I found it very useful because she gave me good advice and spoke to me calmly and nicely.
Kind and helpful
It helps a lot and its nice talking to them because they give good advice on what you need help or support
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6. Emerging National and Local Initiatives
6.1.1 Collaborative Commissioning: National Commissioning for Quality and
Innovation (CQUIN) Transitions
National data indicates that transitions between children’s (CAMHS) and adult mental
health services (AMHS) for young people at the age of 18 are frequently poorly
managed and 25% -50% of young people under 25 years disengage. The CQUIN
aims to:
Incentivise improvements to the experience and outcomes for young people
as they transition out of Children and Young People’s Mental Health Services
(CYPMHS);
Improve joint working across service boundaries.
The CQUIN involves, at least 6 months before transitioning:
1. Joint meeting to plan;
2. Jointly agreed transition plan with personal transition goals;
3. A named and contactable transition key worker
4. A case note audit to assess the extent of Joint-Agency Transition Planning;
5. A survey of young people’s transition experiences ahead of the point of
transition (Pre-Transition / Discharge Readiness);
6. A survey of young people’s transition experiences after the point of transition
(Post-Transition Experience).
The CQUIN Value represents: +2.5% of provider contract Actual Annual Value (AAV)
excluding CQUIN payments and has been implemented across NW London with
monitoring mechanisms in place. As we look to improve our transitions process we
will be building on this quality improvement initiative to develop a comprehensive
pathway between CAMHS and Adult Mental Health services (AMHS).
6.1.2 Collaborative Commissioning: New Models of Care
To address many concerns related to the provision of CAMHS Tier 4 beds including
capacity issues, problems accessing required beds and CYP travelling long distances
to access inpatient care, NHS England promoted the New Models of Care
Programme (NMoC). The programme aims to facilitate and support organisations to
work in partnership to co-design and establish new care models that improve cost
and quality and could be replicated across other parts of the system. In partnership
with CNWL and the Priory Group, WLMHT secured lead provider status to pilot a
NMoC programme to improve access to Tier 4 beds in NW London. The NMoC
project aims are:
Facilitating early discharge and reducing length of stay
Building capacity and capability for CAMHS clinicians to manage young
people and children in mental health crisis in the community more effectively
To admit young people as close to home as possible
Preventing unnecessary admission. Streamlining the process of admission to
discharge with clear plans to facilitate successful reintegration back into the
community,
Ensuring that CYP and their parents are fully involved in shaping their care.
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To ensure the greatest impact the NMoC project initially focused on supporting
adolescents requiring acute generic and eating disorder inpatient care. The service
went live in April 2017 and anticipated savings will be reinvested in local services to
improve crisis care and provide additional intensive community support. The project
embeds the newly funded NW London crisis care pilot to deliver integrated care for
these specific patient cohorts. It is expected if successful; the project will expand to
other patient groups in NW London. Central to the success of the model is the
implementation of Clinical Review and Forward Thinking meetings (CRAFT) which
take place on admission and plan what needs to be addressed for the young person
to be successfully discharged. The programme is monitored by NHSE and future
developments will be agreed as the programme progresses.
6.1.3 Collaborative Commissioning Networks: Forensic CAMHS Service
A new specialist child and adolescent mental health service for high risk young
people with complex needs is due to be commissioned for London (forensic
community CAMHS). This is a national initiative and forms part of the national Health
and Justice and Specialised Commissioning workstream. Funding and the service
specification is being led nationally, but the service will be commissioned and
managed locally by Specialised Commissioning in partnership with Health and
Justice.
The planned service will supplement existing local and other cross-agency provision,
offering consultation and advice, and in some cases, specialist assessment. The
programme is in the early stages of development with the logistics of delivery and the
service specification still to be agreed. We will ensure our existing and emerging work
programmes are aligned to provide seamless care to especially vulnerable groups.
6.1.4 Collaborative Commissioning Networks: Inpatient Care
Although the NMoC focuses on improvement of the management of Tier 4 beds
across NW London, it focuses on two groups of patients; Eating Disorders and
General CAMHS. London Region are in the process of conducting a review of
specialised inpatient care. Initial modelling indicates that nationally there are sufficient
beds but that they are not in the right places in terms of demand. In addition, the
profile of the beds available also do not meet the needs of young people with higher
numbers of general adolescent beds but insufficient provision for those with complex
needs (PICU and Low secure) as well as inpatient care for LD/ASD. We will continue
to align to this evolving work programme ensuring our developments support this
national work programme.
6.1.5 Health Based Places of Safety
In 2016 the Healthy London Partnership (HLP) led on the development of a pan-
London 136 pathway. This has progressed to an options appraisal for Health Based
Places of Safety for both adults and children. We will be liaising closely with HLP to
ensure future recommendations are embedded across NW London. This will be
incorporated into our evolving crisis and home treatment work programme.
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7.1 Enabler One: Co-production
7.1.1 Our Ambition
Our ambition is to embed co-production throughout our programme, developing our
pathways, services and new ways of working in partnership with our CYP, and their
parents and carers.
7.1.2 Our Progress
Co-production within the NW London Like Minded Programme is delivered in
partnership with our lay colleagues the Making a Difference (MAD) Alliance and our
recently appointed third sector partners Rethink Mental Illness. Rethink will support
the MAD Alliance in their strategic roles through coaching and training as well as
increasing the capacity of MAD Alliance as a service user/carer network to co-
produce key recommendations across the whole Like Minded programme.
Existing Rethink community engagement channels will be used, and new ones
developed, to run campaigns to collect insights from a diverse and representative
range of CYP together with their parents and carers across NWL according to the
needs of each co-production task and finish project. Insight gathering will be done
through surveys, focus groups, idea jams and interviews. MAD Alliance Advisors
(Parents and young people) sit on our main steering groups and are key members of
task and finish groups.
Young people have been fully involved in supporting the design and evaluation of our
programmes including: -
Young Champions from Rethink evaluated both our Eating Disorder and Out
of hours services developing a report and feeding back though our
programme local implementation groups.
CNWL and West London patient groups being involved in service design
Children and young people were key participants at our NW London Early
Intervention and Prevention Event.
Each CCG has individual co-production plans to support the local transformation
plans. These are set out in each annex
7.1.3 Next Steps
2017/18
Continue to build on our existing co-production structures
Work with Rethink to develop a comprehensive co-production strategy.
Establish ways to engage the wider community in our early intervention and
prevention plans.
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7.2 Enabler Two: Workforce Development
7.2.1 Our Ambition
To meet our trajectory of enabling at least 35% of NW London children and young
people with a mental health diagnosis to access services, we must expand our
current provision. This requires a substantial increase in our workforce. Across NW
London the aim is to build capacity, capability and competency to support the design
and delivery of services. Establishing a robust learning programme to underpin
transformation will enable change to occur at scale and pace.
The NW London Workforce Development and Training component of the
transformation programme seeks to ensure local plans meet national specifications
set out by Health Education England (HEE) and NHS England (NHSE). In addition, it
aims to drive the development of integrated services and working practices by
facilitating changes in culture and practice.
7.2.2 Our Progress
Assessment of Education and Training Needs
To identify the training needs for NW London an assessment was undertaken by the
Anna Freud Centre (AFC) as part the wider NW London Needs Assessment in 2016.
The main recommendations were to:
Prioritise evidence based interventions as set out by NICE such as the
Early Intervention Foundation and Centre for Mental Health;
Involve experts-by-experience in training development and delivery;
Consider programmes that have a train-the-trainer component to build
capacity in the system to deliver further training and build skills and
knowledge across the system;
Use a model of joint training and/or cross system training –where parts of
the system come together for a training event to share learning and build
capability;
Make use of expertise within the borough in the delivery of training so that
reciprocal arrangements can be delivered;
Make use of local outcomes data as part of training;
Develop a plan for the wider workforce and community representatives
National Child and Maternal Health Intelligence Network Comprehensive CAMHS
Integrated Workforce Planning Tool, the health London Partnership compendium of
training, and the AFC Needs Assessment are all utilised to support the development
of our strategy and work plan.
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Expert Reference Group To ensure there is a strong clinical voice in our transformation programme we have
established a Clinician to Clinician forum which supports the development of the
clinical aspects of our programme. A fundamental function of this group is act as the
expert reference for the education and training programme.
Understanding our workforce
The capacity of our workforce has increased with additional investment allocated into
local CAMHS provision in 2017/18 to establish eating disorder and out of hour crisis
teams, improve access and reduce waiting times. The workforce has increased by
approximately 66.3 whole time equivalent (WTE) posts with an additional 46.2WTE
still to be recruited in 2017/18 attributed to the expansion of the crisis service.
Further work will commence in 2016/17 to identify where additional staffing resources
are needed in parallel with the development of our new service delivery model. This
includes the Recruit to Train (RTT) and Children’s Wellbeing Practitioner (PWP) posts
that are part of the national drive to increase evidence based practice led by Health
Education England. Numbers of RTT and CWP posts recruited are set out in table 31
on page 54.
National Education and Training Requirements NHSE and HEE are working in partnership to deliver a national workforce
development programme which will radically improve the quality of care delivered by
children and young people’s mental health (CAMHS) services (Children and Young
People’s: Improving Access to Psychological Therapies -CYP IAPT)
All services should be working within the CYP IAPT programme with at least 3400
staff trained by 2020/21 on specific therapies, supervision, organisational change and
team development. On a NWL level this means identifying, year on year, staff for
CYP IAPT training and subsequently working with trusts and other services to ensure
that staff can be released and the target is met. Across NW London this equates to at
least 136 staff members trained. Table 28 defines the current number of staff trained
by WLMHT and CNWL.
Table 29: CYP IAPT Trained Staff in NW London
Provider
Number of Staff trained for CYP
IAPT 2016/17
Number of Staff enrolled on training
course for CYP IAPT 2017/18
CNWL 21 To be confirmed
WLMHT 12 To be confirmed
As national funding support or CYP IAPT is discontinued, detailed plans on how
CCG’s will fund training are set out in each individual annex. So far 26% of our target
has been achieved.
11
Five Year Forward View Mental Health https://www.england.nhs.uk/wp-content/uploads
/2016/02/Mental-Health-Taskforce-FYFV-final.pdf.
54
To achieve the proposed expansion in access to high quality mental health care for
children and young people, a significant number of additional staff will be required.
It is estimated nationally an additional 1,700 more therapists and supervisors will be
required. Across NW London this equates to 68 additional staff. Of the 68
approximately three quarters should be therapists and one quarter supervisors. Table
29 below sets out the illustrated trajectory based on NHSE calculations set out in the
5YFV-MH11.
Table 30: Additional Staff Requirements
Clinical Staff 2016/17 2017/18 2018/19 2019/20 2020/21
Therapist 8 17 17 9 3
Supervisor 2 4 4 2 1
As part of the development of the workforce development and training strategy, clear
plans will be developed to specify how the expansion in the workforce will be
achieved.
Table 31: Workforce Expansion CWP and RTT
Capacity Building in the Wider Workforce To deliver the ambition of the NW London CYP Mental Health and Wellbeing
Transformation Plan, it is essential children and young people can access the right
help and support at the right time. Developing new ways of working, utilising
alternative pathways and up skilling generalist staffing groups will be a key
component to support us ensure timely access to intervention. This will include being
able to access non-specialist care much earlier and in an environment which meets
the individual needs of CYP. It is therefore recognised those who have a relationship
with children, both in a professional and non-professional context can effectively
provide support and signpost to appropriate local services. Applicable staff include: -
Local authority staff
Parents and carers
Education staff
GP and primary care staff
General health staff (school nurses, health visiting teams and allied
health professionals)
Children centre staff
Voluntary sector
Community programmes and youth services,
Drug and Alcohol services
Staff Brent
Central London
Ealing H&F Harrow H’don H’slow West London
Total NW London
RTT 0 0 0 0 0 0 0 0 0 CWP 0 4 0 4 0 0 4 4 0
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Across NW London a significant number of programmes are already in place and are
outlined in each annex. Going forward we will be developing a work force strategy to
redesign the system.
7.2.3 Next Steps 2017/18
Establish our plan in partnership with our Local Workforce Action Board
In tandem with developing our new service delivery model, develop our Education and Training Strategy for the wider workforce.
Define workforce training needs required to implement new ways of working and deliver evidence -based care
Map training available and identify gaps.
Scope available providers – working with HEE and HENWL, professional bodies and procure providers
2018/19
Evaluate strategies implemented
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8.0 Equality and Health Inequalities Historically we have had relatively good local intelligence on the needs of our
communities and have worked collaboratively to address local inequality and target
hard to reach population. We have worked in collaboration with our public health
colleagues to develop our plans and updated and changed our approach to address
unexpected or new needs such as the significant emotional and mental health
support and intervention required by our families affected by the Grenfell Tower Fire.
We have an asset based approach building on the numerous resources within our
communities to build resilience across our population.
To engage our population, we have worked in partnership with a variety of community
groups (with Health Watch, schools via the Healthy Schools Partnership, local youth
groups, third sector agencies and current service providers’ user groups). We do
however recognise that wider input is required to ensure we have a representative
view of our local population and support our existing coproduction plans.
Across NWL we undertake an Equalities Impact Assessment when we initiate large
change programmes. At this stage in the programme we have completed the
screening phase of this process which provides a structure to address firstly who our
changes will impact and any gaps in our plans.
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9.0 Governance and Risks The Steering Group supporting the development of this plan has brought together the
key representatives from the eight CCGs – as well as tasking the leads to engage
locally with the wider teams not represented at the table. The Steering Group reports
formally to the NWL Mental Health and Wellbeing Transformation Board – which is
accountable to its constituent CCGs and Health and Wellbeing Boards. The Board is
multi-agency and has oversight of the entirety of mental health and wellbeing
strategic development across NW London.
We have also formed (or re-started) 3 dedicated multi-agency implementation groups
and support groups to aid the development and delivery of projects
WLMHT Implementation Group which includes associated CCGs: Ealing,
Hammersmith & Fulham and Hounslow
CNWL Implementation Group which includes associated CCGs: Brent,
Central London, Harrow, Hillingdon and West London
Clinician to Clinician forum aimed at engaging staff from across the system to
embed clinical quality.
As well as reporting to the Steering Group, these groups have a clear link to local
governance structures.
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Our over-arching governance model links the NWL Mental Health and Wellbeing
Strategy with the 8 NWL CCGs and Local Authorities, with clear governance and
reporting to ensure shared ownership of delivery of our transformation plans (as
shown below).
In developing our plans – and in ensuring we continue to work collaboratively across
North West London - we have a clear governance structure at the NWL level. We
also know that transformation happens at the local level and much of our plans will be
delivered locally. Each CCG has a clear structure for engaging different agencies in
delivering change – these ensure connections to local decision making bodes in
CCGs and Local Authorities as well as the right links to wider children’s work and
mental health developments:
The Transformation Board at a NWL level has NHS England representation providing
a clear link to specialist commissioning and Health in Justice teams.
Further to our over-arching governance arrangements, the governance structures of
each CCG are outlined in detail below.
Children and Young People’s Transformation Plan
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RISK MANAGEMENT As NWL transformation programme progresses, we will continue to re-evaluate our risks. Our current risks are outlined in the table below:
RISK REGISTER
Description Impact
Inherent Risk
Rating Avoidance / Mitigation
Residual Risk
Rating
R1
There is a risk of wider context of funding reductions to CCGs and Local Authority
This will have an effect on activity and resource for transforming mental health services for children and young people.
16 The NW London CYP Mental Health and Wellbeing Service Delivery Framework will be developed in partnership therefore financial risk will be shared across the system and optimising financial benefits and savings.
12
R2
There is a risk that sufficient workforce is not available to meet the new roles (volume and skills/ capability) within the new service delivery framework.
Full implementation may not be possible and cost and quality improvements will not be fully achieved.
16 A workforce strategy is in development which sets out the plans to ensure the wider CYP workforce have the right skills to deliver the right intervention at the right time. We are aligning to National HEE education and training directives and implementing designated initiatives across NW London.
9
R4
A lack of good quality data is available
We will be unable to demonstrate the cost and quality impact new services and new ways of working will bring
12 Development of a dashboard to demonstrate current activity levels and allow for monitoring of impact of the new service delivery framework.
6
R5
Limited financial modelling has been undertaken and costing are estimates.
Difficult to ascertain if we are obtaining value for money and ensure long term financially sustainable services.
12 Robust business plan and costing model being developed.
6
R6
Limited buy in, capacity and engagement from other agencies e.g. education and local authority.
Difficulty developing, new ways of working and new pathways
12 Development of a communication and engagement strategy to ensure wider sector are aware of benefits and risks of the change
9
R7
There is a risk that the CYP programme is not aligned to other work programmes e.g. NHSE Forensic Crisis Service
This could lead to duplication and a disjointed approach to NW London transformation
9 Structures implemented to ensure information sharing and alignment
6
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ANNEX A: Brent CCG (attached as a separate document) ANNEX B: Central London CCG (attached as a separate document) ANNEX C: Ealing CCG (attached as a separate document) ANNEX D: Hammersmith and Fulham CCG (attached as a separate document) ANNEX E: Harrow CCG (attached as a separate document) ANNEX F: Hillingdon CCG (attached as a separate document) ANNEX G: Hounslow CCG (attached as a separate document) ANNEX H: West London CCG (attached as a separate document)
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ANNEX I – Engagement Log
In the development of this plan we have consulted widely with our Children and Young people, their parents and carers, our and key partners across schools, social care and health teams. Evidence can be supplied on request. The table describes the key groups and populations we have actively engaged with – however at a local level our developments have been informed by on-going discussions with a far greater range of people.
Brent CCG
Central London CCG
Ealing CCG
Hammersmith & Fulham CCG
Harrow CCG
Hillingdon CCG
Hounslow CCG
West London CCG
NHS England Specialised Commissioning (CAMHS)
NHS England Mental Health Team
Brent Council
Westminster City Council
The Royal Borough of Kensington and Chelsea
The London Borough of Hammersmith and Fulham
Ealing Council
Harrow Council
The London Borough of Hillingdon
The London Borough of Hounslow
Healthwatch Brent
Healthwatch Central London
Healthwatch Ealing
Healthwatch Hammersmith and Fulham
Healthwatch Harrow
Healthwatch Hillingdon
Healthwatch West London
Central and North West London Mental Health Trust
West London Mental Health Trust
Health Education North West London
Youth Justice Teams
Healthy Schools Partnerships
Rethink Young People
Imperial College Healthcare NHS Trust
Central London Community Healthcare NHS Trust
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ANNEX J – Glossary of Terms
ADHD Attention deficit hyperactivity disorder
A group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
ASD Autistic spectrum disorders
A condition that affects social interaction, communication, interests, and behaviour.
CAMHS Child and adolescent mental health services
Services that work with children and young people who have difficulties with their emotional or behavioural wellbeing.
CBT Cognitive behavioural therapy
A talking therapy that can help you manage your problems by changing the way you think and behave.
CCG Clinical commissioning group
Groups of local GPs and other health professionals who commission most of the hospital and community NHS services in the local areas for which they are responsible. Commissioning involves deciding what services are needed and ensuring that they are provided.
CLCCG Central London clinical commissioning group
The clinical commissioning group responsible for commissioning health care services for the residents of the borough of Westminster (excluding the areas of Queens Park and Paddington).
CNWL Central and North West London NHS Foundation Trust
An NHS provider of mental health, sexual health, physical health, addictions, eating disorder and learning disability services.
CORC CAMHS outcome research consortium
A group of mental health providers, schools, service users and researchers to work together to develop and improve the effective and routine use of outcome measures in work with children and young people (and their families and carers) who experience mental health and emotional wellbeing difficulties.
CQUIN Commissioning for quality and innovation
A payment framework that enables commissioners to reward excellence, by linking a proportion of healthcare providers' income to the achievement of local quality improvement goals.
CYP IAPT
Children and young people’s increasing access to psychological therapies
A service transformation programme delivered by NHS England that aims to improve existing child and adolescent mental health services working in the
community.
DBT Dialectical behaviour therapy
A type of talking therapy based on cognitive behavioural therapy (CBT) that has been adapted to meet the particular needs of people who experience emotions very intensely.
DfE Department for Education
The government department responsible for education and children’s services in England.
ED Eating disorder A mental health condition characterised by an abnormal attitude towards food that causes someone to change their eating habits and behaviour. The most common eating disorders are anorexia nervosa, bulimia, and binge eating disorders.
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ESCAN Ealing service for children with additional needs
A joint initiative between Ealing Primary Care Trust and Ealing Council, working towards a single point of information with improved access to referral, assessment and appropriate interventions for children and young people with disabilities in the borough.
Future in Mind
The Department of Health’s policy on promoting, protecting and improving our children and young people’s mental health
The policy makes a number of proposals the government wishes to see by 2020 including tackling stigma and improving attitudes to mental illness, introducing more access and waiting time standards for services, establishing ‘one stop shop’ support services in the community and improving access for children and young people who are particularly vulnerable.
GP/s General Practitioner/s Doctors who deal with a whole range of health problems and provide health education, offer advice on smoking and diet, run clinics, give vaccinations and carry out simple surgical operations.
H&F Hammersmith and Fulham
The London borough of Hammersmith and Fulham.
JSNA Joint strategic needs assessment
A process by which local authorities, clinical commissioning groups, and other public sector partners jointly describe the current and future health and wellbeing needs of its local population and identify priorities for action.
LA Local authority An administrative body in local government responsible for providing a range of services for local residents including children and family services and health and adult social care.
LAC Looked after children A child who is accommodated (which means that the council is looking after them with the agreement, at the request or in the absence of their parents) or subject to a Care Order made by the Family Courts.
LD Learning disability A reduced intellectual ability and difficulty with everyday activities – for example household tasks, socialising or managing money – which affects someone for their whole life.
Like Minded
The mental health and wellbeing strategy for North West London
A strategy that encourages working in partnership to look at how we can deliver excellent, joined up services that improve the quality of life for individuals, families and communities who experience mental health issues.
MDT Multidisciplinary team A team of professionals with different qualifications and experience who work together to provide a total package of care.
ND Neurodevelopmental disorder
Disorder that can affect children and young people's development, including their intellectual, motor, communication, behaviour and / or social development. The most common
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neurodevelopmental disorders are attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD).
NHS National Health Service
The universal healthcare system in the United Kingdom.
NHSE National Health Service England
The leadership organisation of the National Health Service (NHS) in England. They set the priorities and direction of the NHS and encourage and inform the national debate to improve health and care.
NICE National institute for health care and excellence
A non-departmental public body, accountable to but independent of government that provides national guidance and advice to improve health and social care.
NWL North West London The north west region of London that includes the London boroughs of Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea and Westminster.
OOH Out of hours Outside of normal business hours of 9am to 5pm Monday to Friday.
ROMS Reported outcome measures
Measures that provide a means of gaining an insight into the way patients perceive their health and the impact that treatments or adjustments to lifestyle have on their quality of life.
SAFE Situational awareness for everyone
A two year programme led by the Royal College of Paediatrics and Child Health which, in partnership with 12 hospitals, is developing and trialling a suite of quality improvement techniques.
SEND Special educational needs and disabilities
Learning difficulties or disabilities that make it harder for them to learn than most children and young people of the same age.
TAMHS Targeted mental health in schools
A national project to transform the way that mental health support is delivered to children aged 5 to 13, to improve their mental well-being and tackle problems more quickly
WLCCG West London clinical commissioning group
The clinical commissioning group responsible for commissioning health care services for the residents of the boroughs of Kensington and Chelsea and the Queens Park and Paddington areas of Westminster.
WLMHT West London mental health NHS trust
An NHS provider of mental health services for a range of conditions or illnesses affecting people’s psychological wellbeing.
WTE Whole time equivalent A unit that indicates the workload of a full time employed person.
YOT Youth offending team Teams of professionals that work with young people that get into trouble with the law, are arrested, or taken to court, and help them stay away from crime.
