Jacqueline Cornish
- 1. NHS England – Children & Young Peoples Programmes in Mental Health Dr Jacqueline Cornish NCD for CYP & Transition NHS England Manchester 16th March 2017
- 2. www.england.nhs.uk 2 “Children need champions – strong leaders who will advance their interests – at all levels in the NHS.” - Professor Sir Ian Kennedy, 2010
- 3. www.england.nhs.uk CYP are embedded in key programmes in NHS England Cancer: the independent taskforce made recommendations to NHS England considering specific needs of children, teenagers and young adults Mental health access and waits: programme of transformation of CYP mental health services is underway Learning disabilities: aim to reduce inpatient admissions for those with LD/autism applies to children and complements EHCP Urgent & Emergency Care: children form one of the ‘lenses’ through which the proposed new model of care will be viewed. Long-term conditions: the model of care planning, house of care model, and recent resources developed are mostly applicable to children and young people Specialised Commissioning developing leading edge science and innovation to enable patients with rare diseases to be treated most effectively New care models: Aiming to work with interested vanguards, UEC and acute care collaboration vanguards to support focus on CYP NHS England business plan, 2016/17 Genomics: The Genome project will enable conclusive diagnosis in some rare childhood diseases, and allow treatment to be tailored
- 4. www.england.nhs.uk 4 Improving quality of care Developing future models of care Promoting physical and mental health & wellbeing NHS England’s approach Improving outcomes for CYP Child Health Digital Strategy
- 5. www.england.nhs.uk Child Health Digital Strategy - Context "Develop integrated health and care statistics" ‘Knowing where every child is and how healthy they are’ ‘Appropriate access to information for all involved in the care of children’
- 6. www.england.nhs.uk Why focus on children’s health and information? ➢ Public Health England and the NHS Outcomes Framework 2015/16 stress that a focus on children’s health is essential and that we should be striving to provide the best start in life possible for our children. ➢ The recent National Maternity Review has highlighted that this begins not just with the newborn child but with the mother’s experiences in pregnancy and the birth itself. ➢ The importance of ensuring this good start for the future health of children for the sustainability of the NHS and the economic prosperity of Britain is one of the key themes of the Five Year Forward View. ➢ We need to redesign information services to support the new emphasis on: • the importance of early interventions and preventive measures • integration across different care settings, particularly joining up maternity and newborn care – Perinatal mental health and early development • the need to enfranchise children, young people and parents as equal partners in their care. ➢ We also need to take on the challenges posed by the current organisation of information services.
- 7. www.england.nhs.uk 0d 5d 8d 11d 7w 9w 12m 13m 24m 40m 4y 5y NIPE Bloodspot Hearing NewBabyReview 6-8WeekExam 8/12/16wkImms 12mthReview 12/13mthImms 2/2.5yrIntegReview 3yr4mthImms 4-5yreyesightcheck SchoolEntryChk Year6Check Year8HPV BoosterImms Public Health EnglandPersonalHealthProfessionalHealthPublicHealth Commissioners Directors of Public Health & Children’s Services Delivery of Healthy Child Programme (All Children) Delivery of all other care services (Some Children) CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD School NursingPrimary CareHealth VisitingMidwifery Education Services Voluntary Services Mental Health Services Emergency & Acute Services Justice ServicesSocial Services Community Services Neonatal Services Maternity Information Systems Screening Information Systems Primary Care Systems GPESCYP Dataset CAMHs Dataset PCHR 90 CHRDs Research & Policy Maternity Dataset SCR National Audit
- 8. www.england.nhs.uk Central data sharing hub (3 to 5 years)
- 9. www.england.nhs.uk 9 “Integrated care is about joining things up in order to meet health needs, and in ways that make sense to children and their families. Therefore it should make an important contribution towards improving child health” - Wolfe et al, 2016 Integrated Care
- 10. www.england.nhs.uk NHS England’s activity in 2016/17 is set out in these three broad themes 10 Theme Work to be progressed in 2016/17 Improving and integrating physical and mental health and wellbeing Transformation of CYP Mental Health services Reducing childhood obesity Improving care for CYP with long-term conditions e.g. Epilepsy, Asthma, Diabetes, Complex Disabilities & End of Life Care Improving student physical and mental health outcomes Improving quality of services Service reviews of neonatal critical care, paediatric general surgery and paediatric intensive are – led by specialised commissioning Improving care for children with complex needs, including learning disability and autism with greater personalisation of care through the Integrated Personalised Commissioning Programme Improving the child death process – simplifying procedures, and establishing a national database for better identification of modifiable factors in deaths and trends Improving Transition from paediatric to adult services Developing future models of care Working to develop New Models of Integrated Care for CYP, opportunities through the creation of STPs, the Integration Collaborative and Commissioners Forum Support to the development of pilots to improve decision making around CYP in
- 11. www.england.nhs.uk 11 Long Term Conditions • Improved Outcomes • Integrated Mental and Physical Health • Transition to Adulthood • Student Health National Paediatric Asthma Collaborative
- 12. www.england.nhs.uk Childhood Obesity – co-existent MH 12
- 13. www.england.nhs.uk CYP Mental Health 13 The report makes a series of recommendations: Maximise mental health and wellbeing throughout childhood
- 14. www.england.nhs.uk Common themes 14 CYP Mental Health Future in Mind & Five Year Forward View • Promoting resilience, prevention and early intervention. • Improving access to effective support. • Care for the most vulnerable. • Accountability and transparency. • Developing the workforce. • Promoting good mental health and preventing poor mental health. • A 7 day NHS – right care, right time, right quality. • Complex need services nationally from 2016. • ‘Hard-wiring’ mental health across the NHS.
- 15. www.england.nhs.uk Future In Mind and the FYFV for Mental Health By 2020, for people of all ages we want to see: Publications Gateway Ref. No. 03250 And for children and young people specifically: Improved crisis care for all ages: right place, right time, close to home Improved transparency, leadership and accountability across whole system More visible and accessible support Improved public awareness less fear, stigma and discrimination Timely access to clinically effective support More evidence based, outcome-focused treatments Better use of data and information across the network Professionals who work with children and young people trained in child development and mental health Model built around the needs of children and young people, and a move away from the ‘tiers’ model Improved access for parents to evidence-based programmes of intervention and support A better offer for the most vulnerable children and young people
- 16. www.england.nhs.uk Key issues Access Waiting times Vulnerable groups Transition Economics of investment Infrastructure/resources Systems £78 Average spend per child 0-17 yrs 6.6% CYPMH as proportion of MH spend (2012/13) Not enough is being spent The high cost of getting it wrong The low cost of investing early YP with a MH problem are… • 8x more likely to have contact with YJS • Twice as likely to be claiming benefits Group CBT £229 Unit cost £7,252 Total lifetime benefit Number of 5-16 yr olds with a diagnosable MH condition per 1,000 in England. 102 0.7 Number of WTE CYPMH clinical workforce per 1,000 0-17 yr olds in England. Low workforce capacity Long waiting times Average maximum wait for first appointment (NHS benchmarking) High numbers of referrals Approx increase in referrals last four years referrals 14/15 44% 26 weeks Tiered system 0-25s Thrive Step care models Integrated pathways Varied approaches Various commissioners CCGs LAs NHSE Schools MoJ
- 17. www.england.nhs.uk Contributing to the 2020 vision At least 70,000 more CYP receiving swift and appropriate access to care each year Completed national roll-out of CYP IAPT programme with at least 3,400 more staff in existing services trained to improve access to evidence based treatments 1,700 additional new staff to support improved access to evidence based treatments Evidence based community eating disorder services for CYP across the country 95% of those in need of eating disorder services seen within 1 week for urgent cases & 4 weeks for routine cases. Improved access to and use of inpatient care, having the right number and geographical distribution of beds to match local demand with capacity, and leading to an overall reduction in bed usage. Improved crisis care for all ages, including investing in places of safety By 2020 there will be system-wide transformation of the local offer to children and young people underway, with LTPs embedding Future in Mind principles and fully integrated into STPs across the country:
- 18. www.england.nhs.uk NHS England – CYP MH Delivery Plan • Supporting Transformation – refresh LTP’s to STP’s, pilot currencies, data, dashboard metrics • Workforce development – HEE, CYP IAPT coverage to 100% by 2018 • Generic CYP MH Pathway – 1st point of contact, scheduled care, intensive interventions • Eating Disorders – community ED teams, extend pathway to include in-oatients • Crisis Care – 24/7 emergency response pathway • Specialised (Collaborative – CCG’s) Commissioning • Vulnerable groups – forensic CYPH MH complex needs pathway, Health and Justice Collaborative Commissioning Networks, personal budgets for LAC
- 19. www.england.nhs.uk Prime Minister’s announcement Jan 2017 • Green paper - DfE, DH with a focus on Prevention • More for schools • Mental Health First Aid in schools • Peer Support • RCTs • Extension of training offer for single points of access • Understanding what works in schools settings • CQC and Ofsted review • Digital • ‘Think Ahead’ Social Worker programme
- 20. www.england.nhs.uk CYP MH Schools Link Pilot Objectives In Summer 2015 NHS England and Department for Education jointly funded (£3 million) 22 pilot sites (27 CCGs and 255 schools) to test the named lead approach within CYP MH services and schools and to trial a joint training programme. Develop ways to improve joint working between school settings and CYP mental health services Understand the development and maintenance of effective local referral routes Test the concept of a lead contact in schools and CYP mental health services Understand how training and joint working can improve identification of mental health and well-being issues. Test whether improved knowledge of the system improve timely referrals to appropriate services delivering children and young people’s mental health care
- 21. www.england.nhs.uk CYP MH Schools Link Pilot - Methodology Workshop training sessions aimed to: • develop a shared view of the strengths and limitations and capabilities and capacities of education and mental health professionals • develop knowledge of resources to support the mental health of children and young people • make more effective use of existing resources • improve joint working between education and mental health professionals The workshops used case studies and covered content around depression, anxiety, school approaches to fostering resilience and the use of outcome measures. The aim: long term, sustainable and locally-owned collaboration between schools and CAMHS. The Method: CCGs nominated a named lead responsible as overall point of contact; NHS CAMHS and schools also nominated named leads to develop joint working models. Training was delivered by the Anna Freud Centre using the CASCADE model which was specially designed for the pilots.
- 22. www.england.nhs.uk CYP MH Schools Link Evaluation Methodology: incorporated survey research, research observations and qualitative case studies in a sample of 10 areas and place between September 2015 and 2016. Variety of models tested during the pilot programme. Main areas of variation included: • named individual mental health worker • regular in-school presence • group or 1-2-1 work with children and young people • engagement of wider CYPMHS professionals No single model emerged as being most effective: approaches tailored to local needs and circumstances.
- 23. www.england.nhs.uk Key Findings of the Evaluation Uptake of evidence-based interventions and common outcome measures featured less prominently. Clear evidence of a contribution towards improvements in the frequency and quality of communication between schools and NHS CYPMHS in many areas. Corresponding perceived improvements to the quality and consistency of referrals, without a corresponding net increase in total referrals across the pilot. Very promising early signs of changes to whole school policies, resources and staffing within pilot schools.
- 24. www.england.nhs.uk 24 “It is easier to build strong children than to repair broken men.” - Frederick Douglass, 1818 - 1895