Wigan Borough Clinical Commissioning Group is the statutory body responsible for commissioning local health services in Ashton, Leigh and Wigan.

Introduction

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:

http://www.wiganboroughccg.nhs.uk/your-ccg/news/171-developing-a-greater-manchester-future-in-mind-implementation-plan

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.

Transparency

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.

Governance

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.

Eating Disorders

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.

Early years

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:

Section

Summary

Value

2.2

Waiting list clearance for CYP with ASC

£95k

2.7

Stabilisation of the single point of access and Tier 2 CAMHS

£167k

5.2

Schools link post

£45k

6.2

CAMHS transformation lead posts

£107k

7.9

GM CAMHS Programmes (Crisis Care, i-Thrive)    

£153k

7.11

Community Eating Disorder Service

£190k

 

Total

£757k

                                                                                                                       

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.

 

1000 characters left
Add files

Login Form