Agenda item

(1)          Ms Infanti was welcomed to the meeting. She had been in her position in the team for the past 3 years. Her responsibility is around managing the emotional wellbeing contract and the children in care element of the child and young people mental health service provided by Sussex Partnership Foundation Trust.  Ms Infanti works  alongside West Kent CCG which is  the lead commissioner

Q: Has there been an improvement on waiting times?

 

(2)          The concern around waiting times had been brought to member’s attention and was discussed at previous HOSC meetings. The waiting time has since come down to an acceptable level. Across Kent the average waiting time from referral through to assessment is now at 10 weeks. The average waiting time for treatment (from referral) is now at 16 weeks.

Q: Are you finding pressure from the number of referrals?

 

(3)          The number of referrals has increased dramatically in recent years, particularly emergency and Out of Hours referrals. This is not a pattern unique to Kent and has been seen nationally. Since the start of the contract the number of out of hours referrals has been high, it was anticipated that there would be around 10 per month, it has been averaging around 100. The response to these is within the contract requirements.   90% of children in care had their assessment within 6 weeks, 70% within 4 weeks and 90% had their treatment within 10 weeks.

Q: What sort of problems do these children have? How can we help?

 

(4)          The best way to describe this is to give examples. The first is a 14 year old boy who was in care as he had been experiencing neglect and exposure to substance misuse and domestic abuse. He was referred to the child and young people’s mental health service because of his disruptive behaviour with his foster carers and he would soil himself often. The foster carers also wanted guidance to support him while changing schools. To accommodate for his needs they worked with the network (foster carer, school, social worker, Virtual School Kent) to advise and assist how to respond to his behavioural problems. The children in care CAMHS team also did some direct with the young person. This gave very positive results, his behaviour improved and he successfully moved school and, his attachment to the foster carer improved.

 

(5)          The other example was that of an 8 year old child living with a foster carer, he was expressing distress with disruptive behaviour, being verbally aggressive and trying to run away. This child was supported by the children in care CAMHS working with the network, helping the foster carer change how she responded to the child’s behaviour and by the school providing play therapy.

Q: In this first example, did the boy in question move schools to go to his new placement?

 

Yes, he did move schools for the new placement.

 

Q: Are you seeing an increase of issues that come about due to cyberbullying?

 

(6)          An increase in cyberbullying has been recognised. Providers are aware that is the case and are prepared to deal with it. Young Healthy Minds have had a number of cases involving the use of social media. Their staff are fully aware of safeguarding issues and have/will be attending KSCB e-safety training.

Q: What ability does KCC have to provide Therapy to help children in care with mental health conditions?

 

(7)          I would like to briefly outline the new emotional wellbeing and mental health services that KCC and the CCGs are planning to jointly commission next year. There are three elements within the new service. Firstly, a Mental Health Service provided by mental health practitioners, this is at the highest level of our new model. It does not include the inpatient beds. This will be a specialist mental health service. Secondly there will be staff with mental health expertise who will work in the community and based in early help units. There will also be more skilled support for children and young people with emotional wellbeing needs provided in universal settings. KCC will commission this service. Currently the Young Healthy Minds Service that KCC commissions, provides a time limited intervention, this is accessed via the early help process. At the lowest/universal level there are school counselling services. In the new model children in care would be able to access therapy  at  the level that was most appropriate to their needs.

Q: How effective is the children in care mental health contract?

 

(8)          It’s a good service. There is a very fast response time to service users. Surveys to ascertain from service users whether they are satisfied have been used, such as the NHS friends and family test, there have been  6 responses for the children in care service - all were positive. The provider also uses  the Commission for Health Improvement Satisfaction Survey. Responses have been positive.

 

Q: How many children have used this service over the past year?

 

(9)          Around 400 to 450 Children in Care are using the service at any one time

Q: What has been built into rewriting the bid for CAMHS to ensure a better service?

 

(10)       The current contract ends next year. Rewriting this will be a whole system approach including the Emotional Wellbeing and Mental Health Contract as I outline earlier. This   is a joint commissioning initiative   with Public Health and Education and Young Peoples Services, Specialist Children’s Services and the CCGs. There will be an additional £1.2m available to help ensure a better service. These additional funds are intended for further resources giving more support before escalation into specialist mental health services. These resources will be used to up-skill workers and provide more drop in services. They will work with children and young people in complex family situations where this is impacting on the child’s mental health.

 

(11)       There has been a great deal of consultation around this to inform the new whole system model. Two summits were held last year, young people were involved in making a video, there was a good response to the online consultation and more recently the Kent Youth Parliament has also been given the chance to discuss  the model  and share their ideas to give young people input into this service.

 

Q: How involved will schools be?

 

(12)       There will be strong involvement of schools. Early Help workers will build links to particular schools so this service is easily accessible.

Q: Will this incorporate children seeking asylum who need support with mental health?

 

(13)       Yes. They have been included in this.

Q: Which of the commissioned services you are responsible for is most used in assisting children in care?

 

(14)       There are a number of services that are commissioned for children in care by various officers in the commissioning unit. For example, there is a 12 week programme in which intensive support is provided to prevent children going into care which is used to great effect this is provided by Core Assets. Another example is providing an independent visitor services which aims to improve outcomes for children in care.

Q: We understand waiting times have improved, but what is the new target when the new service is up and running?

 

(15)       Details of the specifications for the new services are still being discussed, at this time we have an outline proposal which is subject to change. Under the new service our target for waiting times for children in care is 2 weeks from referral to assessment. The new service will also address the delays that have been incurred by some groups of children that need specialist support e.g. children on the autistic spectrum.

Q: How well does CAMHS provide for 16-17 years old and care leavers who need support with mental health?

 

(16)       If a child has ongoing issues which means they will need to continue to access mental health services after they reach adulthood there is a transition protocol. This will be used to move children smoothly into adult mental health services to meet their needs. This will normally be planned before they leave the children’s mental health service which begins in the months prior to them turning 18. It includes a period of joint working and parallel care between the children’s and adult mental health providers.

Q: After their first treatment how long usually is it until the following treatment?

 

(17)       This is usually agreed with the young person and their carer. There is no definitive answer.

Q: Do you feel there are enough qualified professionals for this service?

 

(18)       Yes, when considering the children in need service. The Trust, like other providers has sometimes found it difficult to recruit clinical staff with the right qualifications. When thinking more broadly about emotional wellbeing and mental health services there needs to be a range of staff with different professional disciplines.

Q: What is the nature of most of your complaints?

 

(19)        Early on the complaints were focused around the delays in waiting times for assessment and treatment. This has been resolved by the far better waiting times that have been achieved. More recent challenges have been around the availability of tier 4 bed facilities.

Q: How many of Kent’s Children in Care are being sent out of country to access tier 4 secure facilities, due to difficulties accommodating them within the county?

 

(20)       NHSE are responsible for commissioning tier 4 beds.. In August 38 children needed a tier 4 bed, 1 was a child in care with a learning disability who needed specialist provision and therefore had to be placed out of the county

Q: How many children end up in a police cell following emotional problems for their own safety?

 

(21)       I don’t have those figures available. Young people may be in a police cell as a result of criminal activity, it should not be as a result of mental health issues. The Trust have a rapid response home treatment team which responds to emergency situations, the aim of the team is to prevent admission and support young people in the community

Q: Has Sussex Partnership Foundation Trusts service improved?

 

(22)        Yes, they have improved significantly. They have focused on improving the waiting list and now have a good balance.

Q: What are the actual waiting times in each District? Do these vary?

 

(23)       The data on waiting times haven’t been recorded by district previously.  The Trust has introduced a new system and will now be recording the children in care data by districts. This will be easier to provide in future. CCG data could also be supplied which may give some insight into any major difference in waiting times between the districts.

Q: What measures can we take to enable us as effective Corporate Parents?

 

(24)       The best action to take is to keep abreast of developments at a national and local level, as well as performance information,  stay up to date with relevant Government documents e.g. the Department of Health report ‘Future in Mind’; changing legislation and continue to discuss strategy. Focusing on issues such as ease of access, timely access and initiatives designed to promote resilience.

Q: There is no reason why some of this service shouldn’t be sub-contracted, are you keen on new models that include this?

 

(25)       That’s to come in future discussions, a procurement group is being set up to look at the procurement process and contracting arrangements.

 

(26)       There were no other questions and the Chairman thanked Carol Infanti for her attendance at the Select Committee.