Created: Monday, 05 June 2017 16:51
Wigan’s Child and Adolescent Mental health Services (CAMHS) Local Transformation Plan (LTP) was first published in December 2015.
The plan is based on our vision that the Children and Young People (CYP) of Wigan Borough are confident and resilient individuals who are connected to their communities and are able to make an effective contribution as responsible citizens. As a commissioner, we want them to feel safe and care about their health, education and employment, and their community.
CAMHS are a fundamental component of our commissioned children’s services, and our CAMHS LTP set out our ambition to redesign our services by 2020 to create a model for CAMHS that supports our vision by developing:
- Integrated, place based working that is visible and active in communities;
- linked to Schools, Early Years Settings, Start Well Centres and GPs; and
- builds on the wider workforce capacity for the promotion of positive mental health and well-being.
In February 2017, the CCG published an update on progress so far, showing how CAMHS transformation funding has already enabled Wigan Borough CCG and Wigan Council to deliver some key changes to the service, which have started to improve mental health services for children. The update can be found on the CCG’s website:
The objective of refreshing the plan now is to outline how we intend to use the funding to continue to transform services, and also to address the issues raised by the Education Policy Institute’s Mental Health Commission national review of LTPs.
Although our plan was assured by NHS England, the Education Policy Institute’s review highlighted that there were areas for improvement in relation to: transparency; involving Children and Young People (CYP), ambition; early intervention; and governance. The progress in these areas is set out in the following sections.
Understanding local need. Wigan’s CAMHS LTP used national and local data on prevalence of mental health problems to identify the mental health need of CYP in Wigan, and to inform the redesign of our services. An annual needs assessment completed across the CAMHS footprint identifies how effectively CAMHS are meeting the identified need across the locality.
The latest update has highlighted a challenge locally for CYP with Autism Spectrum Conditions (ASC) and with ADHD. It is estimated from local data sources that there are over 700 CYP in the Borough with ASC and a further 1,500 with ADHD. A number of these children are, or will end up in statutory services as a result of the challenging behaviour associated with their condition. Currently there are over 200 CYP waiting for a diagnosis of ASC, and an 18 month wait to diagnosis. With our key educational partners (Educational Psychology Services and Targeted Education Support Services) the development of the ASC pathway and reduction in the waiting list is a key priority for the LTP in 2017/18, and financial resources have been prioritised for this.
Current service provision. The current service offer for CAMHS in Wigan has changed recently following engagement and conversations with a variety of service users and stakeholders.
At the time of the original CAMHS LTP, CAMHS was commissioned via a partnership model between Bridgewater Community Healthcare NHS FT and the 5 Boroughs Partnership NHS FT (5BP). At the end of February 2017, the services that were provided by Bridgewater (Single Point of Access and Tier 2 CAMHS) transferred to the 5BP.
The 5BP changed its name to the North West Boroughs Healthcare NHS Foundation Trust (NWB) on the 1st April 2017. NWB now provides the Single Point of Access, Tier 2 and Tier 3 CAMHS in Wigan. The next step is to move away from the traditional tiered offer and implement iThrive and asset based approaches in 2017/18.
From the 1st April 2017 the arrangements for commissioning CAMHS locally has also changed. Wigan Borough CCG and Wigan Council now jointly commission specialist CAMHS locally under a section 75 agreement to secure future partnership arrangements around children’s emotional and mental health needs.
A continuing challenge of the current service offer is to have timely access to the service and realistic waiting times. Wigan Borough CCG and Wigan Council are working closely with NWB to produce transparent and reliable data on access and waiting time following the transfer of services in February. Reduction in waiting times is a key priority for the LTP in 2017/18.
Workforce development needs. The CCG and Local Authority are working with NWB to re-design and review the clinical need and demands of this service in line with I-thrive and our local DEAL asset based approach.
All the professionals working in the service demonstrate a commitment to engaging our young people in their care and also use CYP IAPT goals and assessment tools to help engage and devise treatment plans. The CCG and Local Authority are currently engaging with providers to ensure swift and appropriate data flow of these outcome measures to demonstrate effectiveness of the service and therapeutic interventions.
Locally, as it is nationally, recruitment and retention of experienced skilled clinicians is an area of significant challenge. In Wigan, we have embraced the enhancement of the whole workforce and engaged with CYP IAPT to plan for a long term investment in our workforce.
By using initiatives such as the schools links pilot, local expertise of our safeguarding training board and national available training we are developing a series of training opportunities for our workforce across the Wigan footprint.
The continued development and delivery of the Wigan LTP, including the adoption of the iThrive model, is an ongoing transformation of all services for young people within our borough which requires collaboration between all agencies to ensure children and young people receive an integrated response from health, social care and education partners.
In order to achieve this the CCG and Local Authority are re-visiting the partnership arrangement within CYP-IAPT to extend it to social care providers, and we are committed to engagement with our third sector providers to further enhance the emotional and wellbeing offer to our young people.
Involvement of children and young people
There was an extensive period of consultation with children and young people in the borough in relation to Emotional Health and Well Being, which was used to develop the CAMHS LTP.
We have continued to engage with CYP through established forums including Youth Forum, Youth Cabinet, SHOUT, and Voice’s for Choices, (A specific group for Children In Care and Care Leavers).
Transformation funds have already supported a campaign for children and young people in Wigan, delivered by young people to raise awareness of mental health; and provide an understanding of self-care strategies
Members of Wigan Council’s Total Rethink group produced a short film called ‘My Hidden Mind’ and an accompanying workshop pack for teachers and youth group leaders https://www.youtube.com/watch?v=_oPBOXrDJ2Y
Total Rethink youth group is helping to develop the borough’s plans around mental health services for young people and is campaigning to change the perception of mental ill health.
In 2017/18 we are supporting specific CAMHS engagement events, and task and finish groups of service users, young people and families in one of our 5 localities. This transformational team of experts by experience will help us continue to develop our local CAMHS offer making sure that the patient journey and the redesigned service offer holds young people at the centre and that they are actively involved in the new model.
Level of ambition
The ambition set out in the LTP is to deliver a CAMHS transformation programme which implements in full the recommendations of Future in Mind and the Five Year Forward View for Mental Health by 2020/21.
The Five Year Forward View sets out an expectation that by 2020/21 there should be a significant expansion in access to high-quality mental health care for children and young people. At least 70,000 additional children and young people each year nationally will receive evidence-based treatment – representing an increase in access to NHS-funded community services to meet the needs of at least 35% of those with diagnosable mental health conditions.
Details of how we are using our additional funding to support our ambition over the next two years are set out in section 7
Early intervention including links with schools and GPs
Ten schools in the Borough have been involved in the schools link pilot. The pilot offer to schools includes:
- Dedicated support of a named CAMHs lead to work closely with two named leads from each school;
- Half termly multi-agency consultation to discuss children and young people where schools have concerns;
- Responsive, timely and flexible community-based assessment, interventions and input from specialist CAMHs professionals;
- Tools and training to support schools in identifying concerns for individual pupils’ emotional wellbeing, and delivering appropriate in-school responses
- Formulation of a whole school ‘Emotionally Friendly’ quality baseline to support school development; and
- Integrated referral to specialist services via Early Help.
The principles and good practice learnt from the pilot will be replicated in one locality in the borough in 2017/18. A CAMHS lead will work within a local authority community based team (Start Well New Delivery Hub, SWNDH) aligned to 24 schools and 12 GP practices covering a population of 40,000.
This locality based offer will be supported by the delivery of a variety of traditionally commissioned CAMHS interventions from within the SWNDH such as groups, training, 1-1 sessions and consultations to other professionals.
The long term aim is to create access to multi agency hubs with a variety of professionals who can respond and meet the needs of the community despite the presenting need their needs will be met within the community resource or appropriately supported to the relevant service via this route. To ensure appropriate education to all community professionals on a range of emotional and mental health issues to educate staff to ensure they have the appropriate skills to respond and meet the needs of young people and appropriately refer is to offer education and consultations to both GPs and SWNDH.
Wigan has an established local Future in Mind Delivery Group which is responsible for overseeing the effective delivery of the LTP and makes sure that the Wigan Health and Wellbeing Board and Wigan Children’s Trust are updated with progress. The group meets monthly and has representatives from all the local commissioning and provider organisations, the community and voluntary sector and from education. The Terms of Reference of the group can be downloaded at the bottom of this page.
The LTP is also supported directly by two CAMHS transformation leads who are commissioned from NWB to provide clinical input to the development and delivery of the plan.
The governance surrounding the delivery of our LTP has been strengthened by the developing alignment with the Greater Manchester (GM) Mental Health Strategy. Wigan is part of the GM Future in Mind Delivery group, a consortium of all 12 GM CCGs/10 Local Authorities with representation from the Strategic Clinical Network, NHSE Specialised Commissioning and Public Health.
Greater Manchester is now working towards a whole system approach to the delivery of mental health and well-being services that support the holistic needs of the individual and their families, living in their communities. This will bring together and draw on all parts of the public sector, focus on community, early intervention and the development of resilience. Six of the thirty two strategic initiatives identified with the GM Mental Health Strategy relate to children and young people. Mental Health has also been identified as a key priority area within the review of Children’s Services currently underway across GM.
Next steps for 2017 -2019
The NHS Operational Planning and Contracting Guidance 2017-2019 sets out the requirements for CCGs to deliver to implement the Mental Health Five Year Forward View for all ages. For Children and Young People, this includes:
- More high-quality mental health services for children and young people, so that at least 32% of children with a diagnosable condition are able to access evidence-based services by April 2019, including all areas being part of Children and Young People Improving Access to Psychological Therapies (CYP IAPT) by 2018; and
- Commissioning community eating disorder teams so that 95% of children and young people receive treatment within four weeks of referral for routine cases; and one week for urgent cases; and
- Increase access to evidence-based specialist perinatal mental health care, in line with the requirement to meet 100% of need by 2020/21, and ensure that care is in line with NICE recommendations.
Access to high quality mental health services – crisis care
One of the pillars - strategic golden threads - in the GM Mental Health and Wellbeing Strategy is to improve Access, which is responsive and holds clear arrangements that connect people to the support they need at the right time. Under this an early priority to introduce 24/7 mental health and 7 Day community provision for CYP has been established.
To deliver this priority a whole system approach is required that includes bringing together commissioning, simplifies the provider system, includes involvement from the independent and third sector and holds children and young people and those who care for them at the heart of change.
Across GM it is acknowledged there is a lack of community out of hours, 24/7 crisis care services for children and young people. The CCG supports the GM aim that by January 2018 we will have developed and implemented a 24/7 crisis care support pathway for children and young people providing easy access to services that are responsive and provide appropriate help across all of GM.
The aim of this transformational change is to reduce duplication and make more efficient use of available resources to achieve better outcomes including a vision for integrated leadership, commissioning and delivery. There is a real opportunity to use the collective intelligence, experience and resources across GM to develop a crisis care pathway for children and young people that is innovative, accessible and effective supported by extended community provision across 7 days to provide wraparound crisis prevention help.
To deliver this aim, GM wide integrated mental health crisis prevention, assessment and support pathways for children, young people and families which are available 7 days per week are being developed.
Work has started through the Children and Young Peoples Mental Health Board to review the current provision from a range of perspectives; to scope best practice across the region and beyond; to consult widely with all stakeholders; and to connect with associated transformational processes e.g. GM Crisis Concordat, Mental Health Liaison Strategy, Local Transformation Plans, Childrens Services review, Youth Justice Review and NHSE CAMHS Tier 4 and Secure Procurement review.
The next stage is to co-produce and articulate a multi-agency and single system response that maps onto the Thrive model for CAMHS; developing an emotional well-being and mental health service for children, young people and those who care for them that is supported by locality wrap around service and provision that seek to prevent a journey of escalation and/or increasing severity and complexity. The key principles of the emerging pathway are described below:
- GETTING ADVICE (COPING) - Prevention services across 7 days accessible through a range of mediums and in a range of settings
- GETTING HELP - Early Intervention and improved and timely access to support for a young person in distress. Aimed at reducing risk and enhancing early interventions. This evidence based approach will be underpinned by enhanced training and support for multi-agency teams who may be first responders or who are already engaged with the young person.
- GETTING RISK (INTENSIVE) SUPPORT – A flexible crisis response with access to risk assessment, advice and support 24:7 from a confident and well trained multi agency workforce with access to appropriate hospital and community based places of safety and/or intensive home treatment teams who can support young people in crisis in their own homes.
- GETTING MORE HELP - Follow up and prevention of future crises through effective multi agency care planning, improved access to evidence informed interventions and increased delivery of help in community settings including a young person’s home.
As part of the finance plan outlined in Section 8 there is a requirement for Wigan to invest and support the GM Crisis Care approach in order to improve health outcomes for young people across our locality and GM, which seeks to reduce the requirement for acute and long term care.
The GM offer will be underpinned by current best practice providing a range of options for young people in crisis, meeting their immediate needs effectively. It will reduce the use of A&E as a first response to crises and reduce the use of paediatric wards while awaiting assessment.
The Wigan and Bolton Children and Young People’s Community Eating Disorder Service, provided by North West Boroughs Healthcare NHS FT was successfully launched on the 1st April 2017.
Finalise our strategic ambitions in respect of early years, based on our existing Parent and Child Mental Health Pathway which has been updated to align with the Greater Manchester 8 stage Early Years model and our commitment to expanding frontline workforce capacity to support positive attachment and bonding.
Vulnerable Young People
Our partnership recognises that our most vulnerable young people are often open to a number of services, which can be fragmented and result in increasing demand within our statutory services. In the most extreme cases, this results in young people becoming looked after due to the lack of community response. In response we will develop a new approach to our residential, fostering and edge of care services, which will make sure that emotional health and well-being is a core component of the services, along with timely access to CAMHS expertise and therapeutic intervention. We are committed to reducing the number of adolescents entering care through a holistic asset based approach to the delivery of our multi agency care plans.
Finance, Workforce and activity
The funding that’s been allocated to Wigan Borough CCG for Children and Young People’s mental health in 2017/18 is £757k. The priorities for the allocation are detailed above and summarised in the following table:
Waiting list clearance for CYP with ASC
Stabilisation of the single point of access and Tier 2 CAMHS
Schools link post
CAMHS transformation lead posts
GM CAMHS Programmes (Crisis Care, i-Thrive)
Community Eating Disorder Service
All local partners are working together, through the Wigan Future in Mind Delivery group, to ensure the best use of existing as well as new resources, so that all available funds are used to support improved outcomes in line with the Mental Health Five Year Forward View.
Progress will be monitored via local performance indicators and the GM Future in Mind dashboard, which is under development. This will include clear outcomes including: waiting times; self-harm related admissions; tier 4 admissions; children being educated in Wigan Schools; and children in care being looked after in the borough.
CAMHS transformation funding will provide additional capacity in our specialist mental health services and we are working with NWB to review the current position in terms of numbers of staff, skill mix and capabilities following the transfer of the Single Point of Access and Tier 2 services in February 2017. A full update on workforce will be published in May 2017.
Section 2.7 highlighted the lack of transparent and reliable data on access and waiting time following the transfer of services to the NWB in February. We are currently reviewing the data with NWB and will publish a full update in May 2017 on the current position in terms of: referrals made/accepted; initial and follow-on contacts attended; waiting times; and CYP in treatment.
Created: Tuesday, 07 March 2017 16:35
As the Greater Manchester Health and Social Care Partnership has become established it is clear that a considerable amount of Future in Mind transformation planning and commissioning is best done to scale across the GM footprint rather only at a single LA/CCG footprint
Some aspects of service planning and delivery will only support improved outcomes when commissioned and delivered more at scale. The partnership has agreed that a GM transformation plan is developed by the end of March 2017. This plan will incorporate objectives outlined in local plans and in turn local plans will need to reflect where planning and implementation will be at a GM or local level.
An overview of where GM planning and service development could be best achieved at a GM level is outlined below.
To read the latest update on Wigan's Children and Young People Mental Health Transformation Plans, download the document below.
Across Greater Manchester (GM), a number of strategic groups, including GM Children’s and Maternity Commissioning Consortium, the GM Future In Mind Group, the Greater Manchester Mental Health Strategy - Children and Young People’s Mental Health Group, Association of Directors of Children’s Services (GM Children’s Services Review) have identified key areas of mental health and emotional well-being for children and young people as transformation priorities.
A collaborative approach across the 10 Local authority footprints is enabling the sharing and implementation of good /best practice, development of consistent care pathways and quality standards, leading to improved quality and equitable services across GM.
Collaborative projects will deliver more efficient use of resources by commissioning and delivering some services at scale. The costs of Specialist CAMH Services are unlikely to be reduced, but efficiency will improved as a result of an implementation of THRIVE informed service delivery which will result in increased throughput. Additional efficiencies will be delivered by reducing the numbers of professionals involved in complex families for whom managing risk is the primary support/intervention.
Transparency and Governance
Transparency and governance supporting the refresh of the 10 GM LTPs has been strengthened as a result of the developing alignment of the Greater Manchester (GM) Mental Health Strategy. An experienced commissioning manager chairs the GM Future in Minds Delivery (currently a consortium of all 12 GM CCGs/10 Local Authorities with representation from the Strategic Clinical Network, NHSE Specialised Commissioning and Public Health and has regular input from NHSE’s GM Assurance and Delivery Manager).
All CCGs have provided additional funding to enable the chair to be seconded into the GM Strategic Clinical Network to provide commissioning subject matter expertise and to provide expert advice within the context of an “honest broker” role
From April 2017 we will have a Greater Manchester Future in Mind Implementation group in place. Membership will include:
- · CCG, Public Health, and Local Authority CYP commissioning leads
- · NHS and independent sector providers – children young people and adult mental health services.
- · Voluntary Faith and Community Groups representation
- · Local Authority Children’s Services lead
- · Children young people
- · Parents/Carers
- · Schools and Colleges (in time universities)
- · Youth Justice lead for GM
- · Mental health of LAC clinical lead
- · A LA SEND lead acting on behalf of all 10 LAs/CCGs
- · NHSE – specialised commissioning and GM Assurance and Delivery Manager.
- · SCN – Clinical leads CAMHS/AMHS , commissioning advisor, network manager and quality improvement lead
Future Governance arrangements
Greater Manchester’s Health and Social Care Partnership will by, April 2017, establish a Children and Young Persons Board that will oversee a whole system transformation of GM’s children and young persons’ services. This board will be chaired by a senior officer from the partnership and will provide the governance for the GM Future in Mind Transformation plan.
We will collaborate with GM’s other local transformation partnerships to develop and implement a single performance and outcomes framework. The planned GM framework will draw from the best practice already developed by local transformation partnerships, and will be informed and shaped by the voices of children and young people. (Patient reported outcome measures)
The GM outcomes framework and dashboard will also be informed by learning from the children and young persons’ IAPT programme
We will continue to work with local transformation partnerships to peer review and challenge implementation progress, spending and impact of transformation ambitions.
The availability of whole system accurate and timely information relating to commissioned and provided services remains a challenge. Under the umbrella of the GM Health & Social Car Partnership we will contribute to the development of GM data systems that will improve both the quality and timeliness of available information.
The voice of Children Young People and their carers
Developing an effective voice for children and young people is a priority for our partnership and we use the learning from our engagement work to date to improve our local processes. With other GM Local Transformation Partnerships we will implement the recommendations of a report prepared by Youth Access that was commissioned by Greater Manchester’s Strategic Clinical Network, and establish a GM Future in Mind reference group for children and young people
Drawing upon effective children and young persons’ participation work developed across GM’s 10 local authorities we will work with colleagues from the 3rd sector to enable children and young people to have a strong voice in developing and implementing the GM transformation plan.
We will work with parents and carers to develop a GM parent/carer reference group to ensure that they become effective stakeholders in helping shape the development review and delivery of services for children and young people
GM iTHRIVE hub
Along with GM’s other local transformation partnerships were are committed to the continued rollout and embedding of the Thrive Model to inform this whole system approach to improving access to information, guidance, advice and high quality treatment. In 2017, the Thrive model (i-Thrive) will start being applied to the whole GM children and young persons’ system to help deliver improved access, reduced waiting times and help deliver clinical efficiencies (more people seen within the resource envelope).
The development of a partnership with the Anna Freud Centre to develop a GM I-THRIVE Hub (hosted by the GM SCN) that will provide additional capacity to lead a whole system approach to transforming services for children and young people.
Out of Hours and Crisis Liaison Service
One of the central tenents of the GM Mental Health and Wellbeing Strategy is to improve access, which is responsive and holds clear arrangements that connect people to the support they need at the right time. As a consequence, a priority has been established to introduce access to 24:7 Mental Health provision and 7 Day Community Provision for CYP.
To deliver this priority, a whole system approach is required that includes bringing together commissioning, simplifies the provider system, includes involvement from the independent and third sector and holds children and young people and those who care for them at the heart of change. This whole system change has already started and will continue into 2017/18
We will continue to support the development of a GM Out-of-hours and Crisis Liaison Service (including extension of RAID to under 16’s) that will be accessible to all children and young people in crisis (not just those with a perceived mental health crisis.) We will work with GM’s local authorities and mental health services providers to develop a GM wide multi-agency offer that is informed by single GM standards and GM wide trusted processes and tools.
Improved access to advice and support
We will support the implementation of the iTHRIVE framework at a GM level and support an iTHRIVE informed co-production of a GM E platform that will provide advice information and access to on line counselling or support for children young people and their carers.
We will be advised by children and young people so that any offer is both credible and acceptable to young people.
Utilising best practice from GM’s 10 local transformation partnerships we will collaborate with the other partnerships to develop the capacity of GM’s third sector and independent sector to develop standards and pathways for children and young people to quickly access evidence based interventions in non clinical settings. Efficiencies will be achieved by commissioning to scale and monitoring done at a larger than single LA footprint
Age and Developmentally Appropriate mental health services for young people
This is a service delivery priority for the GM partnership and with our CAMHS and adult mental health provider services and other key stakeholders including young people we will begin to co-design age and developmentally appropriate mental health services for our 0-25 year old population
In the short term we will across GM support the implementation of agreed transition arrangements between CAMHS and AMHS and work with adult mental health commissioners to develop ADHD and Community Eating Disorder Services for adults.
Community Eating Disorders
We will continue to support the development of a GM CED offer that is delivered via an alliance of clinical providers that enables staffing skills and expertise to be shared across the 3 GM “cluster teams”
We will continue to support the implementation of the agreed GM standards underpinning the delivery of ADHD services for children and young people and we will work with the service providers to ensure that the best practice developed at a local level is delivered at scale across GM.
In Patient (T4) offer for GM -Place Based Commissioning
The provision of mental health inpatient beds for GM’s children and young people is a priority for GM’s partnership. A GM wide task and finish group including specialised commissioning team has been established and has drawn together an alliance of NHS and independent sector providers who are collaborating to develop a GM offer.
We will continue to support the principle of one CCG providing commissioning expertise on behalf of GM
We will collaborate with GM’s CCGs and LAs to scope where a GM wide response to the needs of the following vulnerable groups will improve outcomes/quality and provide system wide efficiencies.
- Mental health services for LAC. Those adopted and care leavers
- Young people involved with the youth justice system
- Children and young people who have LD – cognitive impairment and/or developmental disorders
- C&YP who have Adverse Childhood Experiences
- C&YP originating from minority communities
- Transgender C&YP
We will work with other local transformation partnerships to identify the best current practice in supporting schools and colleges to identify and help students who have challenged emotional well-being and mental health and develop an offer for GM schools/colleges
Early evidence from pilot sites across Gm suggests a shift in referrals to CAMHS, with GP referrals reducing and schools direct referrals increasing and the overall number of inappropriate referrals declining. There is still further work to be undertaken with schools to incorporate self-care for non-service users as part of a whole school approach to mental health – and expanding the CAMHS school link to more schools.
The importance of ensuring that organisations have the right workforce with the right skills and knowledge to deliver effective services is recognised by all and is a key ingredient in creating system transformation through building an effective workforce
With other local transformation partnerships and the GM workforce development team we will collaborate to develop a whole system skills audit that maps onto the iTHRIVE framework
To achieve this we will utilise workforce audit and development tools developed by some partnerships and to use The Self Assessed Skills Audit Tool (SASAT to facilitate the whole work force planning (not just services providing what have historically been regarded as CAMHS T2 and T3 services
Work has commenced through the GM Children and Young Peoples Mental Health Board to review current provision from a range of perspectives; to scope best practice across the region and beyond; to consult widely with all stakeholders; and to connect with associated transformational processes e.g. GM Crisis Concordat, Mental health Liaison Strategy, Local Transformation Plans, Childrens Services review, Youth Justice Review and NHSE CAMHS Tier 4 redesign review, and the GM Transformation Plan will reflect this range of interdependent workstreams