Children and Young Peoples Mental Health Kathryn Pugh Children and Young Peoples Mental Health Operations and Information NHS England December 2017 www.england.nhs.uk By 2020 70,000 more children and young people accessing CYP MH services 1,700 newly qualified therapists working in CYP MH services 3,400 existing CYP MH therapists trained in evidence based treatments Improved Crisis Care for all ages, including places of safety www.england.nhs.uk 95% of those in need of eating disorder services seen within 1 week for urgent cases & 4 weeks for routine cases.
Improved access to and use of Inpatient Care, having the right number and geographical distribution of beds to match local demand with capacity, and an overall reduction in bed usage. The 2020 vision: whole system change Work and health, parenting Association of Directors of Childrens Services DWP ADCS Policing CSA/E DfE HO Education, parenting, childrens social care, Ofsted HEE Prevention,
health visitors School nurses JSNA PHE Provider support MoJ NHS Improvement Whole health system stewardship www.england.nhs.uk Workforce CQC DH Planning assurance Health and Justice
Quality DCLG NHS England Troubled families, social care, housing and built environment Data (activity, outcomes, NHS workforce) NHS Digital Children and Young Peoples Mental Health Green Paper Published 4 December, developed between Department of Health and Department for Education with close involvement from NHS England and Public Health England. It recognises the importance of different settings, not just the NHS. Key themes for consultation Senior lead in schools CYPMH support teams in schools linked to NHS Trial of a 4 week waiting time in a few areas www.england.nhs.uk New funds CYP MH transformation supported by 1.4bn additional funding
announced during 2014/15: 1.25bn over 2015-2020 for wider transformation (including 15m per year for perinatal mental health) 30m per year for eating disorders Additional 25m in 16/17 non-recurrent to reduce waiting lists 5m in 17-18 non-recurrent to improve crisis response Implementing the Five Year Forward View for Mental Health sets out the rising level of funds to CCGs each year In 2016-17 CCGs reported spend of 619m, increase over 2015-16 of 516m www.england.nhs.uk Our programme of work National and regional support CCGs and partners refresh and republish 123 LTPs, incorporated into STPs Maintain system support via MH improvement teams Commissioner development programme: guidance, training and tools Pilot and report on proposed CAMHS currencies for payments Develop national data/MHSDS/dashboard of metrics Workforce development CYP IAPT: increase to 100% coverage by 2018 Support provision of new workforce for improved access (HEE)
Improving access and quality Eating disorders Develop generic CYPMH access to treatment pathway Deliver dedicated community ED teams to meet standards Whole-team training and service specification Extend pathway guidance to include in-patient services Crisis care Develop 24/7 emergency response pathway Test new models of care for CYP in crisis in UEC vanguards Specialised commissioning Recommissioning of Tier 4 beds Guidance to support collaborative commissioning with CCGs Vulnerable groups www.england.nhs.uk
Develop forensic CAMHS/complex needs service and pathway Specialised framework of integrated care across YOIs, SCHs etc. Health and justice collaborative commissioning networks and JSNAs Ensure Care and Treatment Reviews for CYP are in place at transition Test personal budgets for looked after children 2017-18 Progress so far Work area We Said update Implement revised LTP and consolidate into STP Continued CYP and parent participation Set objectives and trajectory to 2020 (including improved access) Joint agency working - schools and colleges , LA, Voluntary sector, providers, Justice
Whole system plans - link to HEE regional leads and Trust based planners Training posts Extending CYP IAPT in more depth new curricula and further training New roles Ensure data including outcomes data is robust and flowing to MHSDS Commission evidence based Easting Disorder Services Plan for Crisis and intensive intervention services Workforce Planning Get ready for Evidence Based Treatment
Pathway trajectory for Eating Disorders, Generic and Crisis As Inpatient Services are recommissioned get ready for further opportunities for joint commissioning Improve joint work with health and justice systems Get to know Police and Crime Commissioners Consider integrated pathways Commissioner Development Programme www.england.nhs.uk Amplified
CCGs submitted tracking Continued through LTPs Many areas have workforce plans but more work required HEE NHSI XX Whole team training for ED CYPWP in training Needs improvement progress In progress 70 teams now in place Completed initial phase In progress In progress First cohort
Participation across whole CYP MH system (national, regional, and local level) 1. Co produce products and resources where are the gaps? what would be helpful? 2. National core and wider interest groups Diverse representation of CYP and parent and carers using services (incl. youth justice, those that tend not to use statutory services) 3. Embed across system through support clinical networks, CYP IAPT collaboratives and partnerships, workshops and masterclasses, monitoring impact at all levels 4. Best practice case studies, videos, resource website, directory www.youngminds.org.uk www.england.nhs.uk In patient recommissioning
To improve experience and outcomes for children and young people in a crisis, their families and carers by ensuring that they have timely access to evidence based care as close to home as possible. In order to do this we need to: Improve local bed availability aligned with the development of 24/7 CYP community services Ensure a sufficient national bed stock for surge management in order to eliminate inappropriate out of area placements Reduce the number CYP attending A&E and their length of stay Reduce the numbers of CYP admitted to paediatric, adult and general acute wards because of a mental health crisis Reduce use of section136 - in inappropriate locations for CYP Reduce number of CYP MH incidents that require police attendance
Develop service specifications to support ambitions www.england.nhs.uk How are we going to achieve this? Work with the whole system to plan and deliver services, including integrating and collaborating with local commissioners and providers Ensure that services are available across the entirely of CYP pathway and increase the number of CYP receiving NICE concordant care Ensure that pathways are appropriate for young people or children with complex needs: Youth Justice, SEND, Children in Care and mental health www.england.nhs.uk In patient re-commissioning Stabilisation Transition Phase 1a 2016
Establishing baseline Planning Mobilising the regions to deliver Communications and engagement Transformation Phase 1b 2021 Phase 2 Phase 1B Stabilising capacity situation where need is greatest Robust bed management Second wave of
new care models Reducing LoS Phase 3 Decommissioning of beds Expanding placebased commissioning Optimising care pathways Transition to community services Delivering savings & investing in community Reduced inpatient numbers and LoS Potential to increase due to the need to
double running: dealing with urgent capacity issues More commissioning at local level Inpatient beds Increase in community services as decommissioning of beds frees up funding Community services 2016 Stabilisation www.england.nhs.uk Transition Reduction in inpatient as community services increase Transformation
final bed numbers not yet known dependent on community investment and other factors 2021 Improving capability and capacity From 2015-2018, contribute towards: CYP IAPT 3,400 existing CYP MH therapists trained in evidence based treatments Support HEE target: 1,700 new staff trained in CYP MH evidence based interventions How are we doing it? Following recruitment of 6th collaborative (HEI with CYP MH services), programme on target to work with services covering 100% of population by 2018 (96%- Aug 17) Services are supported to embed CYP IAPT principles and release staff and to take up the offer of training places HEE recruit to train offer: covers salary support and training costs for new staff; contributes towards achieving 1,700 new CYP MH therapists www.england.nhs.uk Testing Improvements for CYP MH Crisis Care Phase 1 interim evaluation report August 2017.
Findings from two CYP MH Crisis and Liaison Models (County Durham and Teesside) included: On average 60% of CYP referred to crisis services were seen within 1 hour or referral being made and over 75% were seen in 4 hours. Dedicated CYP crisis resolution model identified substantial cost reductions esp to paediatric inpatients Prompt open access to supportive, individualised care with continuity of response highly rated by CYP, families and stakeholders. CYP crises were effectively managed in community settings with less recourse to ambulance transport, A&E attendance and inpatient admission. Crisis presentation similar and remained broadly stable over time. CYP and families contributed to shaping a clear service vision. Dedicated CYP crisis telephone support, advice and triage improved access, response times and provides flexible/individualised support www.england.nhs.uk Eating Disorders (CYP) 95% of those in need of eating disorder services start treatment within 1 week for urgent cases & 4 weeks for non-urgent/routine cases. How are we doing it? Access and waiting time standard introduced in 2016/17 and monitored via MHSDS and UNIFY data collection. The eating disorder pathway is being extended to include episodes of care in day and inpatient settings with the involvement and oversight of the community eating
disorder team Multi-disciplinary community eating disorder teams are being set up across the country Education Systemic family practice curriculum for eating disorder Whole team training available for multi-disciplinary community eating disorder services/teams being delivered 2017 Modality specific evidence based interventions to be in line with updated eating disorder NICE guideline published in May 2017 curriculum for CBTED in CYP IAPT Results Q2 of 17-18 71% of urgent cases seen with 1 week (n=203/286 ) 82% of non-urgent cases seen within 4 weeks (n= 1099/1333) Q2 data shows a rise in the number of CYP entering treatment from 1154 to 1619 All 70 community eating disorder teams for CYP are participating in whole team training www.england.nhs.uk Children & Young People Mental Health Pathway Needs-based, multi-agency pathway. Three key elements 1) First point of access and the initial response (including
signposting to other help) and initial intervention. 2) Scheduled care and evidence based treatment 3) Intensive Interventions and Risk Support, support for complex cases, intensive outreach, the link with inpatient services Expert Reference Groups include representation from a range of professionals (including NHS clinicians, teachers, school nurses, commissioners), commissioners, young people representatives, parent/carer representatives. Draft pathway shared with an extensive virtual stakeholder group. www.england.nhs.uk Opportunities www.england.nhs.uk Changing landscape = opportunity Devolved systems Greater Manchester Surrey Heartlands Accountable Care System Frimley Health including Slough, Surrey Heath and Aldershot South Yorkshire & Bassetlaw, covering Barnsley, Bassetlaw, Doncaster, Rotherham, and Sheffield Nottinghamshire, with an early focus on Greater Nottingham and Rushcliffe Blackpool & Fylde Coast with the potential to spread to other parts of the Lancashire and South Cumbria at a later stage Dorset Luton, with Milton Keynes and Bedfordshire Berkshire West, covering Reading, Newbury and Wokingham
Buckinghamshire www.england.nhs.uk ACSs drive new relationships with providers Children and young people Current system: presentation across a range of settings such as primary care, childrens services, or schools. Pathways to accessing appropriate care differ across different populations, service boundaries and depending on the point of presentation. Results in: unwarranted variations in access, type and quality of support offered in different settings; disrupted points of transition due to complex local system boundaries; possible escalation of needs, system pressures, and poor outcomes particularly for vulnerable CYP at heightening risk of MH problems & who tend to require support from range of agencies (those in care, those with neurodevelopmental disabilities, ASD or long term physical health conditions). ACS opportunities: by minimising interagency silos, ACSs will be able to draw on a range of skills and experience from staff from multiple backgrounds in order to offer appropriate support (e.g. in complex cases), to refer and transfer CYP appropriately ensuring: the right support at the right time; managing of system pressures across different services www.england.nhs.uk New Care Models: while the programme is only a few months in, we are already seeing impact on individual patients Opportunities The programme presents the opportunity to provide seamless community support across a defined population
- this lends itself to an ACS type model Many sites involve multiple providers working across their local area, and it has resulted in increased collaboration and standardisation across these sites As sites have ownership of the pathway, they will invest in additional services, including: Pro-active pathway management, e.g. care navigator roles; commissioning hubs Single point of access assessment Crisis and out-of-hours support Supported housing and employment advice Liaison support and community follow-up provision www.england.nhs.uk In 2016/17 we are interested in trialling with local volunteers: Secondary mental health providers managing care budgets for tertiary mental health services New Care Models in Mental Health coverage www.england.nhs.uk i-THRIVE
10 national accelerator sites in October 2015 72 CCG areas by June 2017 i-THRIVE COP sites are responsible for 47% of children and young people in England. 21 If Id had the help in my teens that I finally got in my thirties, I wouldnt have lost my twenties. www.england.nhs.uk Thank you [email protected] www.england.nhs.uk
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