Five health and local government organisations have today outlined a shared determination to transform emotional health and wellbeing services to make a difference to the lives of children and young people in Hull and the East Riding of Yorkshire.
NHS Hull Clinical Commissioning Group (CCG), NHS East Riding of Yorkshire CCG, Humber NHS Foundation Trust, Hull City Council and East Riding of Yorkshire Council have welcomed the Government’s ‘Future in Mind’ report, which promotes early help and prevention across education, social care and health.
In response to Future in Mind, detailed local Transformation Plans have been developed. If the Plans are approved by NHS England around £1 million investment will be allocated towards local services.
Investment will include providing ‘universal’ support services in schools and communities to identify mental health problems earlier and improving access for the near 2,000 young people in Hull and East Riding who need the support of specialist services like Child and Adolescent Mental Health Services (CAMHS) each year.
Emma Latimer, NHS Hull CCG Chief Officer said:
“Our vision is for all children and young people in Hull to be happy, healthy and safe, both now and in the future.
“We have seen a 100% increase in referrals over the last 14 months to CAMHS. This has shown how critical it is to have support in place much earlier in children’s lives to promote good emotional health and wellbeing.
“The transformation plan is a joint commitment across health and the local authority towards turning this situation around. We are thinking innovatively, putting strong partnerships in place and setting ourselves ambitious targets to deliver the changes needed.”
Jane Hawkard, East Riding of Yorkshire CCG Chief Officer said:
“East Riding of Yorkshire CCG has already invested in CAMHS early in this year in recognition of the need to improve services. Whilst we have made a good start we now want to focus more attention on bringing together health and social care teams and improving prevention within schools.
“We’re working really well with East Riding of Yorkshire Council and our ultimate aim is to prevent and treat early, well before crisis occurs.”
Our service priorities for the Hull and East Riding area are:
Hull and East Riding Crisis Response Team
A new community crisis response team will be in place by early 2016. The team will be available 24 hours, 7 days a week within the community and will work closely with a range of other out-of-hours services to support young people and their families in emergency and crisis situations. This represents a joint investment of around £500,000 in the new service, with 11 new staff now appointed by Humber NHS Foundation Trust.
Hull and East Riding Community-based Eating Disorder Service
A new community-based Eating Disorder service will provide new and enhanced community and day treatment for children and young people. The service will work with families and meet the recommended access and waiting time standards - within 24 hours for emergency referrals - within 1 week for urgent cases and within 4 weeks for routine cases.
A focus on earlier intervention and prevention will help to improve outcomes and support transition between services. Additional specialist nurses have been recruited to the £320,000 service which will be operational by the end of March 2016.
Improving waiting times
All partners are committed to providing additional resource to eliminate the current backlog to ensure that by March 2016 no one will wait longer than 18 weeks. In addition, the introduction of the crisis response team will ensure that CAMHS staff can focus on waiting list reduction in both areas (core and crisis).
The current total waiting list for CAMHS is reducing despite increased demand. In Hull (which had a larger number of people waiting initially) there has been a reduction of 40% and the East Riding has seen a 29% drop over the last six months (March to August 2015).
The workforce training and development plan will ensure that we have a trained and skilled workforce across health, education and social care confident in supporting young people.
BRAVE online is a new initiative offering psychiatric treatments and self-help for children and adolescents experiencing separation anxiety disorder, social phobia, specific phobia and generalised anxiety disorders.
In-patient beds (NHS England)
In anticipation of the NHS England-led procurement of additional specialist inpatient (Tier 4) services for children and young people, Humber NHS Foundation Trust is preparing an outline business case to provide these services locally. This is supported by both CCGs, although the financial viability, location and timescales for the procurement will be determined by NHS England.
David Hill, Chief Executive, Humber NHS Foundation Trust said:
"Like similar CAMHS service providers across the country, we have noticed a significant increase in demand for our services, and a steep rise in the complexity and severity of our cases and this has presented challenges for our service.
“In response to this we have worked with our commissioners to introduce a number of new initiatives to help manage the demand. We acknowledge there is still much more to be done to deliver the changes needed to support children and young people earlier and we are committed to work in partnership to achieve this. This will continue to be a priority for our Board.”
Additional early intervention schemes in Hull include:
Early help and prevention
Hull’s Early Help Delivery Model brings together partners from across a wide range of agencies and services and takes responsibility for coordinating early help services which support children and young people’s emotional health and wellbeing from promoting good maternal mental health, whole school approaches and parenting support through to more targeted early intervention with services such as young people’s counselling, young carers support, youth work and peer mentoring.
Children and young people identified their top 5 worries or concerns as – bullying; exam stress; body image; drugs/alcohol and self-esteem and confidence. Additional specialist emotional and mental health capacity in the Early Help Hubs will be provided to support children and young people and ensure appropriate support is accessed at the earliest opportunity.
Additional CBT clinics and mentoring for low mood and anxiety
There will be an extension of the well-received Saturday Cognitive Behaviour Therapy (CBT) clinics in Hull. Additional mentoring for 13 – 18 year olds in Hull with emotional, relationship, wellbeing and mild mental health difficulties is provided by Hull and East Yorkshire MIND from October 2015.
The CCG and City Council HeadStart project operating in 13 primary schools in Hull. HeadStart is a Big Lottery funded project, with the overall aim to improve the emotional wellbeing and resilience in 10-14 year olds and is a major contributor to the Transformation Plan. Learning from this project will inform the ongoing development of services.
Young People’s Counselling
Hull City Council has led the development of a counselling service for 5-19 year olds who are looked after or have social care involvement, and an extension of The Warren’s counselling service will support 10-19 year olds in Hull. These services will ensure young people who need early help for emotional health have access to counselling at the earliest opportunity.
Milorad Vasic, Hull City Council’s Director of Children and Family Services, said:
“Good emotional and mental health and wellbeing is the foundation for ensuring children and young people reach their potential and succeed in life and education.
“We are working closely with partners across the city to provide children, young people and families with coordinated, tailored support at the right time. Only by schools, our voluntary and community sector and public sector services working together can we ensure the right support is in place at the earliest opportunity.”
Additional early intervention schemes in the East Riding of Yorkshire include:
Early Health and Safeguarding Hub
Under the plans CAMHS, in conjunction with EHAS (Early Health & Safeguarding Hub), will offer a single number to ensure all referrals, as soon as they come through, are seen by the most appropriate agency and support provided as early as possible.
For young people in Year 7 presenting with symptoms suggestive of moderate anxiety a new anxiety clinic has been launched across the East Riding. The service aims to help children understand the physical and psychological symptoms of anxiety and enable them to develop positive coping strategies based on a cognitive behaviour therapy approach.
Peri-natal mental health
To support the emotional well-being of pregnant women and their child, partner and families, the peri-natal mental health service has been extended to offer all women in the East Riding of Yorkshire CCG area access to specialist peri-natal support alongside the support available in Hull.
In the East Riding of Yorkshire a dedicated psychologist has been appointed to offer counselling and support for children and young people with diabetes, epilepsy and degenerative and / or life limiting diseases.
Schools lead for CAMHS pilot
It is recognised that CAMHS is only one of many services and organisations responsible for helping children and young people with their emotional and mental health issues. The development of a schools lead for CAMHS in the East Riding of Yorkshire will link the service in more closely with work already ongoing to support children and young people in their school environments.
Kevin Hall, East Riding of Yorkshire Council’s director of children, families and schools, said:
“We are working closely with our partners and through our schools to support young people’s emotional health and wellbeing. We welcome the opportunity that the "Future in Mind" Transformation plan gives us to ensure that children and young people’s emotional needs are met at an early stage. Children, families, schools and communities will benefit from this initiative.”
The development of both Transformation Plans has been greatly assisted by the Northumberland Tyne and Wear NHS Foundation Trust review of CAMHS provision across Hull and East Riding.
The review sought to establish whether current and planned service specifications were fit for the future, whether services were provided as effectively and efficiently as possible and to assist learning and sharing of good practice from other services further afield.
It was acknowledged that the increasing and changing demand for emotional health and wellbeing support has put pressure on local CAMHS staff. There was also recognition that there are “skilled, caring and dedicated staff for young people and each other” in CAMHS who feel they are “proactive about keeping young people safe”.
29 recommendations were made around the following themes:
- Referral and access
- Assessment care and intervention
- Transfer of care
- Staffing and training
- Location, environment and facilities
The majority of recommendations from the review were fully accepted – this includes standardising the referral process across the two areas, teams and age groups, and making improvements to the telephone contact monitoring system.
Eleven of the recommendations have been implemented including two concerning the Contact Point triage process and management of young people aged 16-18 admitted to adult wards.
Fourteen will have been completed by the end of December 2015 with the remaining 4 completed by June 2016 at the latest.
All organisations would like to particularly thank all staff for the hard work they do every day supporting children and young people across the area and that they have positively embraced these plans. Anyone concerned about their mental health and wellbeing is encouraged to seek early advice.
- A guide to the different levels of Child and Adolescent Mental Health Services (CAMHS) is available here
- A summary of the Transformation Plan for Hull is available here and a summary of the Transformation Plan for the East Riding of Yorkshire is available here. The full plans will be submitted to NHS England on 16 October 2015 and will be published following assurance by NHS England.
- Future in mind (Department of Health, 2014) sets out a national vision for promoting, protecting and improving our children and young people’s mental health and wellbeing. It identifies five key themes for local areas to focus on in developing their local transformation plans:
i. Promoting resilience, prevention and early intervention
ii. Improving access to effective support – a system without tiers
iii. Care for the most vulnerable
iv. Accountability and transparency
v. Developing the workforce
Five key objectives included in the August 2015 guidance:
- Build capacity and capability across the system
- Roll out the children and young people’s improving access to psychological therapies programmes (CYP IAPT)
- Develop evidence based community eating disorder services for children and young people
- Improve perinatal care
- Bring education and local children and young people’s mental health services together around the needs of the individual child through a joint mental health training programme, testing it over 15 CCGs