Norfolk Waveneys transformation of mental health pathways for

Norfolk & Waveney’s transformation of mental health pathways for children & young people: Family Voice Conference 10 th March 2018 Jonathan Stanley CAMHS Strategic Commissioner Norfolk County Council & Clinical Commissioning Groups (CCGs)

Aims To outline the current MH system for children & young people in Norfolk & Waveney To explain the rationale for our transformation/redesign programme To outline our vision for mental health pathways in the future To identify ways in which the vision for the future will be developed further Presentation Time for questions/discussion Your comments & contributions very welcome Plug: Q&A session on CAMHS 2 pm-3 pm – Rebekah Muttitt and Nishi Puri (NSFT) White cards in your bags Write down any question/s and return to the CAMHS stand or Reception by 1 pm please

Norfolk & Suffolk County Councils, 7 Norfolk districts and Waveney, 11 parliamentary constituencies Norfolk and Waveney System About 1, 000 people 1 in 4 CCGs Children’s Localities + Waveney 2 community providers 1 mental health trust Icons made by Freepik from www. flaticon. com 5 6 aged 24 & under 1 ambulance trust 3 acute hospitals, about 1, 780 G&A beds 110+ GP practices Copyright © Experian Ltd, NAVTEQ 2016, Based on Crown Copyright material

0 -17 year old population by CCGs in Norfolk & Waveney 204, 507 Norfolk & Waveney 190, 482 35, 207 West Norfolk 33, 157 55, 137 South Norfolk 49, 131 Expected population change % for 0 -17 year old 39, 902 Norwich 12. 00% 10. 90% 36, 563 10. 00% 8. 40% 8. 00% 30, 941 North Norfolk 6. 90% 6. 00% 29, 405 4. 00% 5. 80% 5. 00% 2. 50% 2. 00% 43, 321 GY& Waneney 0. 00% GY& Waneney 42, 226 0 50, 000 100, 000 North Norfolk Norwich 150, 000 2025 2015 South Norfolk West Norfolk & Waveney 200, 000 250, 000

19 -24 year old population by CCGs in Norfolk & Waveney 62, 642 Norfolk & Waveney 69, 709 9, 145 West Norfolk 10, 008 12, 110 South Norfolk Expected population change % 19 -24 year old 13, 721 0. 00% GY& Waneney 22, 597 Norwich North Norfolk -5. 00% Norwich South Norfolk West Norfolk & Waveney -4. 00% 23, 508 -10. 00% -9. 40% -11. 30% 7, 236 North Norfolk -13. 30% -15. 00% 8, 730 -20. 00% -18. 90% -20. 60% 11, 554 GY& Waneney -25. 00% 13, 742 0 10, 000 20, 000 30, 000 40, 000 2025 2015 50, 000 60, 000 70, 000 80, 000

0 -24 year old population by CCGs in Norfolk & Waveney 278, 600 Norfolk & Waveney 271, 698 46, 231 West Norfolk 45, 058 Expected population change % 0 -24 year old 70, 166 South Norfolk 65, 710 6. 40% 7. 00% 6. 00% 5. 00% 64, 983 Norwich 4. 00% 2. 50% 3. 00% 62, 382 2. 50% 2. 00% 1. 00% North Norfolk 39, 925 0. 00% 39, 996 -1. 00% GY& Waneney North Norfolk -0. 20% Norwich South Norfolk West Norfolk & Waveney -2. 00% -3. 00% -2. 20% 57, 295 GY& Waneney 58, 552 0 50, 000 100, 000 2025 150, 000 2015 200, 000 250, 000 300, 000

Current CYP’s providers delivering a MH ‘offer’ Universal incl… GPs Education settings Early Help Teams Children’s Centres Promoting Alternative Thinking Strategies (PATHS) Targeted incl… Point 1 including new Link Work Provision Norfolk Educational Psychology and Specialist Support (EPSS) Specialist incl… Norfolk and Suffolk NHS Foundation Trust (NSFT) Compass Schools (SSSf. N) Compass Outreach Integrated Community Paediatric Services Healthy Child Programme Norfolk Community Health + Care (NCH+C) Safer Schools Partnership James Paget University Hospital (JPUH) Benjamin Foundation YMCA Nelson’s Journey

Nos of CYP accessed treatment in 2016/17 by provider CYP 0 -17 year olds 2016/17) 20, 000 18, 000 16, 000 14, 000 17, 948 [VALUE] (75%) 12, 000 2110 [VALUE] (58%) 4164 10, 000 8, 000 6, 000 4186 2, 000 0 Estimated number with Actual referrals (% of diag. condition total with diag. condition) Nos & % who access treatment by year and age range Point 1 NSFT NCHC

Local innovations, recent developments PATHS programme – over 120 primary schools, 20, 000 + pupils Compass Schools – x 50 places – education & therapy Bespoke offer to Looked After Children & edge of care CYP – Compass outreach & PIMHAT Specialist MH Trust offer to 18 -24 yr olds – Youth MH teams LTP funded developments incl… Increased capacity – CAMHS ED & Targeted CAMH Service (Point 1) Link Work offer to Universal Settings Harmful Sexual Behaviours project – YOT & specialist MH Trust Crisis CAMHS Pathway enhanced

Transformation/Redesign Programme: Background Current pathways not adequately meeting need In 2015 only 36% of children and young people with a mental health problem were seen - 58% by 2016/17 NB Govt target (5 YFV) for 2021 = see/reach 35% Uncoordinated system – further work needed to ensure joined up provision and commissioning and early support. Gaps in provision Not fully taking advantage of efficiencies of working at scale Incremental developments rather than system wide improvement CAMHS redesign approved – 2016/17 refreshed LTP

CAMHS system re-design - Givens Norfolk & Waveney footprint 190 k CYP aged 0 -17 5 CCGs, NCC and SCC Circa 70 k +18 -24 yr olds Must address Statutory duties National targets & policy for NHS & CS – Green Paper, (Evidence Based Pathways, W/T stds) Childrens Services Improvement Plan All levels of need – Universal, Targeted, Specialist Integration – provision and particularly joint commissioning/governance

Project structure & progress Redesign Steering Group Project Initiation Document in place Needs assessment Mapping existing provision, contracts and resources Developing the future service model for Norfolk & Waveney External advice – incl CYP IAPT, East of England Clinical Network Engagement activity Focus groups with CYP (incl Youth Advisory Boards, In Care Council, Dragons), family members/carers, partners, referrers Online consultation, open to all - Aug-Nov 2017 – 285 responses With professionals - schools, WN Community Engagement Forum, NCC Service Development Groups – LAC/Leaving Care, Fostering Advisory Partnership, CAMHS Strategic Partnership CAMHS staff - online consultation Dec 2017 -31 st Jan 2018 and x 3 face to face engagement sessions Testing our early thinking about the scope & potential future service models Our engagement work continues

Parent Infant MH provision Those who access provision generally get a good service Success with recruitment What works well? Collaborative ventures – e. g. Compass Outreach Joint bids & innovations Some meaningful activity, performance & outcome data

Multiple routes into services. Hard to navigate Geographic variation in services Governance/ decision making arrangements not fully integrated Uncoordinated pathways IT systems that can’t talk to each other Providers working to different contracts, KPIs and producing different performance and outcome data Where is improvement needed? Variations in services across age ranges Quality & patient safety concerns Front line staff, management & commissioners not working cohesively Waiting times too long Insufficient focus on system wide relationships Capacity not aligned to demand

A single waiting times standard Bespoke pathways/ service offers for populations with particular or additional needs Friendly drop ins A single, trusted, easy to understand/ access CAMHS system Reach the unreached: more than 58% by 2020/21 What are the design opportunities? Services aligned across the whole N & W footprint Collaboration not competition A common age range supported by all services A single point of contact for all CYP MH provision Using online & smartphone & other technology Proactive, approaches to minimise DNAs Common core offer for all

Our vision for the future Footprint = Norfolk & Waveney Age range = 0 -25 yr olds Increasing no's CYP accessing advice, support, treatment Single entry/contact point for CYP with MH needs One name, website, phone number – whether delivered by several organisations or one Providing advice, support, triage of referrals, support to universal settings and signposting An offer for all who want help – graduated, from validated self-help/online support through to 1: 1 or group face to face support/treatment Service model delivered in line with the Thrive model & its 5 core principles Participation, evidence based practice, rigorous outcome monitoring, improved access, awareness raising A single performance framework, consistently managed - 1 set of KPIs, quality standards, client satisfaction and outcome reporting Compliance with national standards, targets & NICE guidance

The Thrive Model

Some headlines from staff engagement (online & face: face) Strengthen advice & support through/in education settings More link workers to deliver brief interventions, consultation support & to sign post – cluster model? Concern about reductions in universal and targeted (non-MH) community services – e. g. Youth Service, Connexions. Strong support for greater integration – ‘One Service’ & to simplify access routes Change the ‘balance’ to better match targeted & specialist capacity to anticipated need Workforce – ‘sort out’ recruitment/retention challenge & ‘grow our own’ Improve/simplify waiting time standards – transparency re. secondary waits – dedicated support while waiting Improved web-based information, self-help and ‘chat’ facilities Enable IT client records/management systems to talk to other systems – Primary Care, Children’s Services, other key providers General strong support that the age range for CAMHS should be 0 -25 Address perceived boundaries between teams within organisations as well as those across organisations

Any Questions?

Relevant background documents – references & web addresses Thrive Model (2016) https: //www. annafreud. org/what-we-do/improving-help-forprofessionals/service-redevelopment/thrive/ Green Paper, (2017) https: //www. gov. uk/government/consultations/transforming-children-andyoung-peoples-mental-health-provision-a-green-paper Five Year forward View (2014), https: //www. england. nhs. uk/wp-content/uploads/2014/10/5 yfvweb. pdf Children’s Commissioner’s Briefing: Children’s Mental Healthcare in England (2017), https: //www. childrenscommissioner. gov. uk/publication/briefing-childrens-mental-healthcare-inengland/ Norfolk & Waveney Local Transformation Plan, https: //www. norfolk. gov. uk/care-support-andhealth/health-and-wellbeing/childrens-health-and-wellbeing/mental-healthcamhs/professionals